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Nature Jul 2015One of the characteristics of the central nervous system is the lack of a classical lymphatic drainage system. Although it is now accepted that the central nervous...
One of the characteristics of the central nervous system is the lack of a classical lymphatic drainage system. Although it is now accepted that the central nervous system undergoes constant immune surveillance that takes place within the meningeal compartment, the mechanisms governing the entrance and exit of immune cells from the central nervous system remain poorly understood. In searching for T-cell gateways into and out of the meninges, we discovered functional lymphatic vessels lining the dural sinuses. These structures express all of the molecular hallmarks of lymphatic endothelial cells, are able to carry both fluid and immune cells from the cerebrospinal fluid, and are connected to the deep cervical lymph nodes. The unique location of these vessels may have impeded their discovery to date, thereby contributing to the long-held concept of the absence of lymphatic vasculature in the central nervous system. The discovery of the central nervous system lymphatic system may call for a reassessment of basic assumptions in neuroimmunology and sheds new light on the aetiology of neuroinflammatory and neurodegenerative diseases associated with immune system dysfunction.
Topics: Animals; Central Nervous System; Cranial Sinuses; Female; Humans; Immune Tolerance; Immunologic Surveillance; Lymphatic Vessels; Male; Meninges; Mice, Inbred C57BL; T-Lymphocytes
PubMed: 26030524
DOI: 10.1038/nature14432 -
Cell Feb 2021Despite the established dogma of central nervous system (CNS) immune privilege, neuroimmune interactions play an active role in diverse neurological disorders. However,...
Despite the established dogma of central nervous system (CNS) immune privilege, neuroimmune interactions play an active role in diverse neurological disorders. However, the precise mechanisms underlying CNS immune surveillance remain elusive; particularly, the anatomical sites where peripheral adaptive immunity can sample CNS-derived antigens and the cellular and molecular mediators orchestrating this surveillance. Here, we demonstrate that CNS-derived antigens in the cerebrospinal fluid (CSF) accumulate around the dural sinuses, are captured by local antigen-presenting cells, and are presented to patrolling T cells. This surveillance is enabled by endothelial and mural cells forming the sinus stromal niche. T cell recognition of CSF-derived antigens at this site promoted tissue resident phenotypes and effector functions within the dural meninges. These findings highlight the critical role of dural sinuses as a neuroimmune interface, where brain antigens are surveyed under steady-state conditions, and shed light on age-related dysfunction and neuroinflammatory attack in animal models of multiple sclerosis.
Topics: Animals; Antigen Presentation; Antigen-Presenting Cells; Antigens; Cellular Senescence; Chemokine CXCL12; Cranial Sinuses; Dura Mater; Female; Homeostasis; Humans; Immunity; Male; Mice, Inbred C57BL; Phenotype; Stromal Cells; T-Lymphocytes; Mice
PubMed: 33508229
DOI: 10.1016/j.cell.2020.12.040 -
The New England Journal of Medicine Apr 2005
Review
Topics: Anticoagulants; Cerebral Veins; Cranial Sinuses; Fibrinolytic Agents; Humans; Intracranial Hypertension; Radiography; Risk Factors; Sinus Thrombosis, Intracranial; Venous Thrombosis
PubMed: 15858188
DOI: 10.1056/NEJMra042354 -
Journal of Neuro-ophthalmology : the... Jun 2024The significance of asymmetric enhancement on cavernous sinus MRIs in the differential diagnosis of ischemic and inflammatory oculomotor cranial nerve (OCN) palsies...
BACKGROUND
The significance of asymmetric enhancement on cavernous sinus MRIs in the differential diagnosis of ischemic and inflammatory oculomotor cranial nerve (OCN) palsies remains controversial. This study explored the cavernous sinus MRI findings for cavernous sinus idiopathic inflammation (inflammation group), microvascular ischemic OCN palsy (ischemic group), and ocular myasthenia gravis (OMG group) patients.
METHODS
A total of 66, 117, and 60 patients were included in the inflammation, ischemic, and OMG groups, respectively. Cavernous sinus MRIs were retrospectively analyzed.
RESULTS
The abnormality rates of cavernous sinus MRIs for OMG and ischemic groups were 41.7% (25/60) and 61.5% (72/117), respectively. Inconsistency rates between clinical topical diagnosis and imaging findings for inflammation and ischemic groups were 3.0% (2/66) and 13.7% (16/117), respectively ( P = 0.020). In the inflammation group, cavernous sinus thickness, thickening enhancement, and enhancing adjacent lesions were noted in 90.9% (60/66), 71.2% (47/66), and 25.8% (17/66) of the patients, whereas in the ischemic group, they were noted in 51.3% (60/117), 38.5% (45/117), and 0.9% (3/117) of the patients, respectively ( P < 0.001). Among ischemic CN III palsy patients, 55.5% (15/27) and 16.7% (2/12) of the cases had CN III enlargement and enhancement in the diabetic and nondiabetic groups, respectively ( P = 0.037).
CONCLUSIONS
Cavernous sinus MRI abnormalities can be explained by specific pathologic mechanisms of the primary disease based on the complex neuroanatomy. However, suspicious inflammatory changes cannot exclude the possibility of ischemia and over reliance on these findings should be avoided.
Topics: Humans; Male; Cavernous Sinus; Female; Magnetic Resonance Imaging; Middle Aged; Oculomotor Nerve Diseases; Retrospective Studies; Adult; Aged; Young Adult; Adolescent; Oculomotor Nerve; Aged, 80 and over; Diagnosis, Differential; Ischemia; Child
PubMed: 37751328
DOI: 10.1097/WNO.0000000000001958 -
AJNR. American Journal of Neuroradiology Mar 2022In this second of 3 review articles on the endovascular management of intracranial dural AVFs, we discuss transarterial treatment approaches. The treatment goal is to... (Review)
Review
In this second of 3 review articles on the endovascular management of intracranial dural AVFs, we discuss transarterial treatment approaches. The treatment goal is to occlude the fistulous point, including the most distal portion of the arterial supply together with the most proximal portion of the draining vein (ie, the "foot" of the vein), which can be accomplished with liquid embolic agents via transarterial access. Anatomic factors to consider when assessing the safety and efficacy of a transarterial approach using liquid embolic agents include location, angioarchitecture, and proximity of arterial feeders to both the vasa nervosum of adjacent cranial nerves and the external carotid-internal carotid/vertebral artery anastomoses. Anatomic locations typically favorable for transarterial approaches include but are not limited to the transverse/sigmoid sinus, cerebral convexity, and superior sagittal sinus. In this review article, we discuss the technical approaches, outcomes, potential complications, and complication avoidance strategies for transarterial embolization.
Topics: Central Nervous System Vascular Malformations; Cerebral Angiography; Cranial Sinuses; Embolization, Therapeutic; Endovascular Procedures; Humans; Transverse Sinuses; Treatment Outcome
PubMed: 34620593
DOI: 10.3174/ajnr.A7296 -
Surgical and Radiologic Anatomy : SRA Aug 2022We hypothesized that the cranial phenotype influences the shape of the posterior cranial fossa and the relative position of the sigmoid sinus.
INTRODUCTION
We hypothesized that the cranial phenotype influences the shape of the posterior cranial fossa and the relative position of the sigmoid sinus.
MATERIALS AND METHODS
The topography of the sigmoid sinus was studied on 26 magnetic resonance venograms and 35 embalmed cadavers by morphometric analysis, dissection, and photo modeling techniques.
RESULTS
The data show that the transverse diameter of the posterior cranial fossa correlates positively with the laterolateral diameter of the skull. The majority of cases with the low-anterior position of the sigmoid sinus were recorded in the brachycephalic group (82%), while the high-posterior localization of the sigmoid sinus was typical for the dolichocephalic patients (63%). The results of the ANOVA test confirm the significance of differences.
CONCLUSIONS
The shape of the skull reflects the morphology of the posterior cranial fossa and influences the topographic characteristics of the sigmoid sinus that must be considered in the selection of surgical approach to the inner ear and pontocerebellar angle.
Topics: Cranial Fossa, Posterior; Cranial Sinuses; Humans; Neurosurgical Procedures; Phenotype
PubMed: 35871409
DOI: 10.1007/s00276-022-02988-7 -
Surgical and Radiologic Anatomy : SRA Apr 2023The middle fossa, cavernous sinus, and paraclival triangles consist of ten triangles. Their use in a surgical approach is vast; most are used as landmarks to access and... (Review)
Review
The middle fossa, cavernous sinus, and paraclival triangles consist of ten triangles. Their use in a surgical approach is vast; most are used as landmarks to access and identify other structures of surgical interest. Multiple labels, borders, and contents mentioned by different authors make understanding and reproduction challenging and confusing. This study aims to organize and clarify recent or most relevant publications and disclose our portrayal of the ten triangles using cadaveric dissection and simple and practical figures. Four middle fossa triangles, four cavernous sinus triangles, and two paraclival triangles were dissected and delineated in a cadaveric specimen. Drawings were simplified to eliminate confusion and evaluate the triangles effortlessly. Similarities and differences in triangle names, border limits, and contents are described in a precise form. The recognition of triangle landmarks allows for treating pathologies in a frequently distorted anatomy or challenging to access structure. That is why an accurate knowledge of the surgical anatomy should be mastered, and a safe approach should be accomplished.
Topics: Humans; Cavernous Sinus; Neurosurgical Procedures; Dissection; Cadaver
PubMed: 36853414
DOI: 10.1007/s00276-023-03105-y -
Asia-Pacific Journal of Ophthalmology... 2019Diseases of the cerebral venous system frequently lead to neuro-ophthalmic complications. Cortical venous sinus thrombosis and dural arteriovenous fistulas may be... (Review)
Review
Diseases of the cerebral venous system frequently lead to neuro-ophthalmic complications. Cortical venous sinus thrombosis and dural arteriovenous fistulas may be complicated by elevation of intracranial pressure, with secondary papilledema or abducens palsies. There is increasing recognition that stenosis at the transverse sinus-sigmoid sinus junction plays a role in the pathophysiology of idiopathic intracranial hypertension and offers a new avenue of treatment in patients who fail medical therapy. Diseases of the cavernous sinus manifest with their own set of neuro-ophthalmic symptoms, reflecting the presence of all 3 ocular motor nerves and the oculosympathetic fibers within its walls, along with its role as the primary drainage pool of the globe and orbit. Numerous questions and controversies remain regarding the diagnosis and optimal treatment of cerebral venous disease, including the role of venous stenting in idiopathic intracranial hypertension, the role of anticoagulation in cavernous sinus thrombosis, and the risks and benefits of embolization of mild indirect cavernous carotid fistulas.
Topics: Cavernous Sinus Thrombosis; Constriction, Pathologic; Cranial Sinuses; Humans; Intracranial Arteriovenous Malformations; Intracranial Hypertension; Sinus Thrombosis, Intracranial; Stents; Thrombolytic Therapy
PubMed: 30672173
DOI: 10.22608/APO.2018239 -
Neurologia Medico-chirurgica Mar 1994The cavernous sinuses of 50 adult cadavers were examined to investigate the relationships of the blood vessels and cranial nerves, important structures during surgery in... (Review)
Review
The cavernous sinuses of 50 adult cadavers were examined to investigate the relationships of the blood vessels and cranial nerves, important structures during surgery in this sinus. The first and second divisions of the fifth cranial nerve were embedded in the deep dural layer of the cavernous sinus and were supplied by the two main branches of the intracavernous carotid artery. The meningohypophyseal artery supplied the sixth cranial nerve in Dorello's canal and the third and fourth cranial nerves where they entered the dura. The inferolateral trunk supplied the third, fourth, fifth, and sixth cranial nerves. The size of the meningohypophyseal artery was usually inversely proportional to the size of the inferolateral trunk. The capsular artery did not supply the cranial nerves. The cavernous sinus can be approached through various routes: a) superior, through the anteromedial or medial triangle; b) lateral, through the paramedial, Parkinson's, anterolateral, and lateral triangles; c) inferior, through the posterolateral and posteromedial triangles; and d) from the inferomedial walls. The choice of surgical approach depends mainly on the location of the lesion to be treated.
Topics: Carotid Arteries; Cavernous Sinus; Cranial Nerves; Humans; Microsurgery
PubMed: 7516044
DOI: 10.2176/nmc.34.150 -
Neurologia Medico-chirurgica Jun 2016The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with... (Review)
Review
The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery "medial venous axis" carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves "lateral venous axis" are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves "intermediate venous axis" contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage.
Topics: Cavernous Sinus; Humans
PubMed: 27063146
DOI: 10.2176/nmc.ra.2015-0346