Traversing the cavern: radiological manifestations of cavernous sinus pathologies

Abstract Background Owing to their peculiar location, cavernous sinuses communicate with numerous head and neck structures via fissures and foramen which provide an easy access for pathologies to traverse to and from the cavernous sinuses to these vital structures. On routine brain imaging, diseases involving the cavernous sinuses can be easily missed if we are not vigilant to examine cavernous sinuses using dedicated thin sections of sellar and parasellar region. Main body of the abstract The various pathologic conditions involving cavernous sinuses either primarily or secondarily include neoplasms, vascular conditions, cystic/fat-containing lesions and infective/inflammatory conditions. Due to considerable overlap in clinical symptoms of numerous diseases affecting cavernous sinuses, timely and effective imaging evaluation of cavernous sinuses using multimodality approach with dedicated imaging sequences can help in formulating a clinically relevant differential diagnosis and alter patient management. Thin T1- and T2-weighted axial and coronal images with appropriately timed MR angiography and venography should be performed for diagnosis of cavernous sinus pathologies and delineation of pathologies arising from closely placed neurovascular structures in this region of middle cranial fossa. In this review article, we aim to discuss how to best image the cavernous sinuses for detection of cavernous sinus pathologies and imaging appearance of various pathologies involving cavernous sinuses. Conclusion Cavernous sinuses form an important pathway for spread of numerous pathologies to and from the intracranial compartment to nearby vital structures. A variety of conditions can affect these small paired venous structures including benign and malignant neoplasms, vascular lesions, and infective/inflammatory pathologies. It is therefore important that besides routine brain imaging, dedicated thin axial and coronal images along with contrast-enhanced imaging should be performed for diagnosis of cavernous sinus pathologies.