Bildgebung und Histologie von Läsionen des Sinus cavernosus

Eine Vielzahl von Strukturen in engem Zusammenhang mit den Sinus cavernosi kann Ausgangspunkt der Entwicklung unzähliger Erkrankungen mit sich überschneidender Klinik werden. Deshalb spielt die Bildgebung diagnostisch eine entscheidende Rolle. Dieser Artikel beschreibt das multimodale Bildgebungsspektrum und die Histopathologie von Erkrankungen des Sinus cavernosus, gibt wichtige Hinweise für die Differenzialdiagnose und zeigt potenzielle Fallstricke auf.

Abstract

Cavernous sinuses are paired interconnected venous plexuses situated in the floor of the middle cranial fossa on either side of the sella turcica and sphenoid sinus. They are lined by dura mater and consist of multiple venous channels within. The cavernous sinuses are intimately related to the internal carotid artery and its associated sympathetic plexus, the oculomotor nerve, the trochlear nerve, the abducens nerve, and the ophthalmic nerve. Cavernous sinuses are connected to the orbit, the pterygopalatine fossa, the infratemporal fossa, the nasopharynx, and the posterior cranial fossa by various foramina, fissures, and canals in the skull base. A multitude of structures in close relation to the cavernous sinus give rise to a myriad of possible pathologic conditions that can be broadly classified into (a) neoplastic, (b) vascular, (c) infective or inflammatory, or (d) miscellaneous lesions. These pathologic conditions can have overlapping clinical manifestations. Hence, imaging plays a crucial role in identifying the disease, assessing its extent, providing a pertinent differential diagnosis to guide further management, and suggesting a site or route for biopsy. MRI is the modality of choice to depict the cavernous sinuses, with CT and digital subtraction angiography playing supplementary roles in certain situations. In this article, the cavernous sinus lesions encountered in our institution during a 10-year period are reviewed. The purpose of the article is to (a) describe the anatomy of the cavernous sinus; (b) demonstrate the multimodality imaging spectrum of a wide variety of pathologic conditions involving the cavernous sinus, correlating with the histopathologic findings; (c) highlight important imaging clues for differential diagnosis; and (d) help the reader overcome potential pitfalls in interpretation.

Kernaussagen

• Die Sinus cavernosi sind paarige komplexe Venenräume beidseits des Sinus sphenoidalis und der Sella turcica und liegen am Kreuzungspunkt zahlreicher wichtiger neurovaskulärer Strukturen.

• Der Sinus cavernosus kann u. a. von Neoplasien (benigne oder maligne), Infektionen oder Entzündungen, Gefäßerkrankungen und kongenitalen Läsionen betroffen sein. Unterschiedliche pathologische Zustände im Bereich dieser Region können jedoch ähnliche klinische Merkmale aufweisen. Deswegen spielt die Bildgebung eine entscheidende Rolle bei der Bestätigung der Erkrankungen, der Beurteilung ihrer Ausdehnung, der Auswahl weiterer Untersuchungsmethoden und der Therapieplanung.

• Die MRT ist aufgrund ihrer hohen Kontrastauflösung die Bildgebungsmodalität der Wahl für die Beurteilung des Sinus cavernosus. CT und digitale Subtraktionsangiografie sind in bestimmten Fällen von Nutzen.

• Häufige Neoplasien, die den Sinus cavernosus betreffen, sind das Hypophysenadenom, das Meningeom, Nervenscheidentumoren, Kopf- und Halstumoren sowie Metastasen.

• Vaskuläre Läsionen des Sinus cavernosus, d. h. Sinus-cavernosus-Thrombose, Aneurysma der A. carotis interna und Carotis-cavernosus-Fistel, sind große klinische Imitatoren mit breit gefächerten klinischen Manifestationen, deren Schwere von banal bis lebensbedrohlich variiert. Die digitale Subtraktionsangiografie spielt eine wichtige Rolle beim Management von Carotis-cavernosus-Fisteln und Aneurysmen der A. carotis interna.

• Es gibt erhebliche Überschneidungen in den radiologischen Befunden der Sinus-cavernosus-Beteiligung bei infektiösen oder entzündlichen Erkrankungen. Die häufigsten angetroffenen Befunde sind ein massiver Sinus cavernosus und eine verstärkte Kontrastmittelanreicherung, die sich bis in die Orbita oder die angrenzende Dura ausdehnen kann.

Schlüsselwörter

Sinus-cavernosus-Läsionen - bildgebende Diagnostik - histopathologische Korrelation - diagnostischer Algorithmus - Fallstricke

Keywords

Cavernous sinus lesions - imaging spectrum - histopathologic correlation - algorithmic imaging approach - imaging pitfalls

Publikationsverlauf

Artikel online veröffentlicht:
06. Mai 2020

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