This medical anatomical diagram illustrates the surgical field during a pituitary adenoma resection, specifically highlighting the cavernous sinus (CS) anatomy and the fronto-orbito-zygomatic (FOZ) approach. The diagram depicts the intracavernous portion of a pituitary adenoma (rendered in reddish-orange) fully exposed. Centrally, a red vascular structure represents the internal carotid artery (ICA) and its proximal branches. To the right, a yellowish nerve structure representing the III cranial nerve (oculomotor nerve) is shown mobilized and laterally displaced using a surgical self-retaining microretractor. This maneuver widens the access through Hakuba’s triangle (anteromedial triangle), allowing direct visualization and removal of the tumor within the cavernous sinus. The illustration emphasizes the spatial relationship between the tumor mass, the protective pseudocapsule, the ICA, and the mobilized cranial nerves, which is critical for preventing neurovascular injury during complex skull base surgery.

This medical anatomical diagram provides a sagittal perspective of the human cranium, illustrating the complex venous sinus system and dural membranes. The superior sagittal sinus is highlighted along the superior margin within the falx cerebri, receiving tributary veins from the dura mater. Inferiorly, the inferior sagittal sinus runs along the free margin of the falx, joining the great cerebral vein (of Galen) to form the straight sinus. Posteriorly, these structures converge at the confluence of sinuses, which connects to the transverse and occipital sinuses. The diagram further details the anterior and lateral drainage pathways, including the sphenoparietal sinus, cavernous sinus (with intercavernous connections), and the superior and inferior petrosal sinuses. These ultimately drain into the sigmoid sinus before exiting the skull as the internal jugular vein. This illustration is an essential educational tool for understanding intracranial venous anatomy, relevant to neurosurgery, radiology, and managing conditions like dural venous sinus thrombosis.

This medical anatomical diagram provides a lateral view of the human brain, illustrating the complex organization of the cerebral dural venous sinuses and deep cerebral veins. The illustration highlights the superficial and deep drainage systems through a network of blue-colored vessels overlaid on a stylized brain outline. Key structures labeled include the superior sagittal sinus along the longitudinal fissure, cortical veins, the inferior sagittal sinus, and the straight sinus leading to the vein of Galen. Anastomotic pathways are represented by the superior anastomotic vein (Vein of Trolard) and the inferior anastomotic vein (Vein of Labbé). The inferior drainage components shown include the cavernous sinus, anterior and posterior intercavernous sinuses, sphenoparietal sinus, ophthalmic vein, superior petrosal sinus, and the sigmoid sinus draining into the jugular vein. Deep structures like the basal vein of Rosenthal and internal cerebral veins are also depicted. This diagram serves as an educational reference for understanding cerebral venous anatomy, which is clinically significant for diagnosing conditions such as cerebral venous sinus thrombosis (CVST).

This endoscopic clinical photograph displays the microsurgical anatomy of the cavernous sinus and parasellar region, likely viewed via a transnasal transpterygoid approach. The central landmark is the cavernous segment of the internal carotid artery (1), shown as a prominent, vertically oriented vessel. To its medial side are the hypophysis (2) and the inferiorly positioned clivus (3). The lateral wall of the cavernous sinus is dissected to reveal several cranial nerves in their anatomical order. From superior to inferior, the oculomotor nerve (4), the abducens nerve (5), and the ophthalmic branch (V1) of the trigeminal nerve (6) are visible, following a longitudinal course. The maxillary branch (V2) of the trigeminal nerve (7) is seen most inferiorly and laterally, emerging toward the pterygopalatine fossa. The image serves as an educational reference for skull base surgery, illustrating the critical spatial relationships between vascular structures and cranial nerves during surgical decompression or tumor resection in Meckel's cave and the cavernous sinus.

This composite figure illustrates the clinical and radiographic features of septic cavernous sinus thrombosis (SCST) progressing to a carotid-cavernous fistula (CCF). Panel A shows a series of nine cardinal gaze clinical photographs demonstrating bilateral eyelid swelling, incomplete ptosis, and restricted extraocular motility (ophthalmoplegia), notably bilateral exotropia with impaired medial and vertical gaze. Panels B and C are gadolinium-enhanced axial and coronal brain MRI images showing bilateral cavernous sinus expansion with prominent thrombotic filling defects (arrows). Panel D is a CT angiogram of the neck, used to screen for initial arterial involvement. Panel E (follow-up MRI) reveals persistent thrombosis and significant contrast enhancement/enlargement of the cavernous sinuses (dotted arrows). Panel F (Time-of-Flight MR Angiography) displays abnormal high-flow-related signal in the right cavernous sinus (arrowheads), diagnostic of a secondary CCF. Panel G (Digital Subtraction Angiography) confirms the fistula at the distal cavernous segment of the right internal carotid artery (shadowed arrow). The collection documents the evolution of infectious cavernous sinus disease into a vascular complication.

This series of digital subtraction angiograms (DSA) illustrates the endovascular management and longitudinal progression of a traumatic direct carotid-cavernous sinus fistula (CCSF). Image (a) demonstrates the baseline pathology: a massive arteriovenous shunt from the cavernous segment of the right internal carotid artery (ICA) into the adjacent cavernous sinus. Image (b) shows the initial intervention, featuring densely packed detachable coils within the superior ophthalmic vein and cavernous sinus, combined with the deployment of flow diverters within the ICA. Image (c) shows a follow-up DSA 6 days later, identifying a residual shunt that necessitated the placement of additional flow diverters to increase the construct's metal coverage and further promote thrombosis. Images (d) and (e) represent long-term follow-up at 2 and 8 months, respectively, showing complete occlusion of the fistula, absence of venous shunting, and restoration of normal arterial flow. The series highlights a combined endovascular approach using both coil embolization and flow-diverting stents to achieve definitive occlusion of high-flow traumatic arteriovenous communications.

Axial CT angiography of the head demonstrating key diagnostic findings of a carotid-cavernous fistula (CCF). The image shows significant dilation and early contrast enhancement of the right cavernous sinus. This is accompanied by a markedly dilated and tortuous right superior ophthalmic vein (SOV), indicated by a white arrow, reflecting retrograde arterialized blood flow. Clinical manifestations secondary to these vascular changes are visible, including right-sided exophthalmos (proptosis) and enlargement of the extraocular muscles. The medial deviation of the right globe suggests convergent strabismus, clinically associated with abducens nerve (CN VI) compression within the cavernous sinus. This educational image serves to illustrate the classic radiological triad of cavernous sinus enlargement, superior ophthalmic vein dilation, and proptosis in the context of neurovascular pathology.