Medial portion of the cavernous sinus: Quantitative analysis of the medial wall

Abstract

Pituitary tumors invade the cavernous sinus via the medial wall. Researchers have speculated that this wall is composed of dura and that substances secreted by tumors might damage this barrier. In contrast to the lateral wall, little is known about the structure of the medial wall of the cavernous sinus (MWCS). This study provides the first detailed quantitative (thickness) and qualitative (histological) assessment of the MWCS. Eighteen sellar-parasellar tissue blocks were obtained from adult human autopsies. Ten specimens were used for microsurgical dissection and macroscopic anatomical description. Eight specimens were used for histopathological study and for recording computer measurements of MWCS thickness. Each of these eight specimens was divided into three approximately equal-sized pieces, with cuts made in the coronal plane from posterior to anterior starting at the anterior level of the pituitary stalk. Wall thicknesses were compared in the three different regions (posterior, middle, anterior), and also on the left vs. the right sides. The investigations showed that the MWCS is a distinct dural layer that forms a barrier between the medial venous space of the cavernous sinus and the pituitary gland. The mean thickness of the 48 total (left and right) MWCS observed in the 24 sections examined was 0.195 +/- 0.066 mm (range = 0.080-0.387 mm). This wall is composed of loosely arranged collagen fibers that comprise a specific layer known as "meningeal dura." The posterior third of the MWCS was significantly thinner than the middle third (P = 0.0014) or anterior third (P = 0.0001). No macro- or microscopic defects were observed in any of the MWCS in the 18 specimens. The thinness of the posterior MWCS suggests that this is the most likely path for extension of pituitary tumors into the cavernous sinus.