Visualization of cerebrospinal fluid-filled spaces in the cavernous sinus using magnetic resonance imaging

The cavernous sinus (CS) has been extensively studied and is commonly acknowledged as a dural venous sinus. There have been no reports documenting cerebrospinal fluid (CSF)-filled spaces in the CS. Here, we explore such structures in the CS using magnetic resonance imaging (MRI). A total of 183 patients underwent T2-weighted or constructive interference steady-state (CISS) sequence MRI. Imaging data from coronal sections were analyzed. Of the 183 patients, 26.8% had CSF-filled spaces in the CS. These spaces appeared to communicate with the suprasellar cistern through dural defects found in the superior wall of the CS, and also appeared to surround the cavernous portion of the internal carotid artery (ICc) and pituitary gland, and further be adjacent to the oculomotor and trigeminal cisterns. Dural defects were identified in 81.6% of patients, with CSF-filled spaces adjacent to the oculomotor and trigeminal cisterns found in 81.6% and 12.2% of patients, respectively. The distribution of these spaces could be classified into four types based on their topographical relationships with the ICc, namely the circumferential, medial, lateral, and superior types. The circumferential and medial types were the most frequently found and comprised >80% on both sides. The CS may involve CSF-filled spaces in physiological conditions that are formed through dural defects in the superior wall and adjacent cranial nerve cisterns. These findings are critical when considering approaches to the CS, modes of lateral extension of pituitary tumors, and CSF dynamics in the CS.