Circle of Willisand

Cavernous Sinus

Clinical Anatomy

Dr. Ankit M. PunjabiDept of Ophthalmology,

KIMS Hospital,Bangalore

Karnataka, INDIA

drankitalways@gmail.com

CIRCLE OF

WILLIS

TERRITORIES OF MAJOR ARTERIES OF BRAIN

TERRITORIES OF MAJOR ARTERIES OF BRAIN

TERRITORIES OF MAJOR ARTERIES OF BRAIN

Representationto show

major arterial supplyin the Circle of Willis

• Cerebral Infarction • Transient Ischemic Attacks• Vascular Malformations (Aneurysm, etc)• Intracranial Hemorrhage• Tumors of adjacent structures• Inflammatory Diseases of Arteries

Common Sites for Plaque Formation

• Internal Carotid– Ipsilateral blindness– Contralateral hemiparesis– Contralateral hemianesthesia– Hemianopia– Aphasia, hemineglect

• Middle Cerebral – Main trunk : Hemiplegia, hemianesthesia,

hemianopia, Aphasia– Upper division : Hemiparesis & sensory loss ( arm/face > leg)– Lower division : Wernicke Aphasia– Penetrating Artery : pure motor hemiparesis

Common Sites for Plaque Formation

• Anterior Cerebral– Hemiparesis & sensory loss (leg>arm)– Impaired responsiveness

• Posterior Cerebral– Cortical (U/L) : isolated hemianopia

(or quadrantic defect), color anomia

– Cortical (B/L) : cerebral blindness (+/- macular sparing)

– Thalamic : Pure sensory stroke– Subthalamic : Hemiballism– B/L inf temporal lobe : Amnesia– Midbrain : Oculomotor &

other Cr. N. palsy

30-35%

30-35%

20%

5%

5%

• Macular area is watershed area

CAVERNOUS SINUS

CAVERNOUS SINUS

Structures in lateral wall

• Oculomotor nerve• Trochlear nerve• Ophthalmic nerve

• Lacrimal• Frontal• Nasociliary

• Maxillary nerve• Trigeminal ganglion

Structures in centre of sinus

• Internal carotid artery• Men.Hypo. A• Capsular A• A. to Cav sinus

• Sympathetic plexuses• Abducent nerve

VENOUSVASCULATUREOF BASE OF SKULL

1.Sup. Oph. Vein2.Ant. Int. Cav. Sinus3.Inf. Oph. Vein4.Pterygoid Plexus5.Mid. Menng. Vein6.Sup. Petr. Sinus7.Inf. Petr. Sinus8.Basilar plexus9.Transverse Sinus10.Post. Int. Cav. Sinus11.Cavernous Sinus12.Sphenoparietal Sinus

CAVERNOUS SINUS SYNDROMES• Multiple cranial neuropathies:

– Unilateral & isolated 3rd ,4th,5th, 6th nerve palsy– Conbimation patterns of ophthalmoplegia– Painful ophthalmoplegia– Proptosis– Ocular & cranial bruits– Conjunctival congestion, arterialization of conjunctival veins– Ocular hypertension– Optic disc edema/pallor– Retinal hemorrhage– Anaesthesia in ophthalmic division of trigeminal– Horner’s syndrome

CAVERNOUS SINUS SYNDROMES

Carotico-Cavernous Fistula

Cavernous Hemangioma

Intra-Cavernous Carotid Aneurysm

Thank You