THE 8INUSE8 OF THE DURA 



727 



Applied Anatomy. An arteriovenous communication may be established between the 

 cavernous sinus and the carotid artery, as it lies in it, giving rise to a pulsating tumor in the orbit. 

 Such a communication may be the result of injury, such as a bullet wound, a stab, or a blow 

 or fall sufficiently severe to cause a fracture of the base of the skull in this situation, or it may 

 occur from the rupture of an aneurism or a diseased condition of the internal carotid artery. 

 The disease begins with sudden noise and pain in the head, followed by exophthalmos, swelling 



CAVERNOUS 

 SINUS 



>.>* 



PITU ITARY 



:-',B O DY 



TRANSVERSE 

 SINUS 



THIRD 

 NERVE 



FOURTH 

 NERVE 



SIXTH 

 NERVE 



OPHTHALMIC 

 DIVISION OF 

 FIFTH NERVE 



SUPERIOR MAXIL- 

 LARY DIVISION 

 OF FIFTH NERVC 



FIG. 505. Frontal section through the right cavernous sinus, enlarged. (Spalteholz.) 



and congestion of the lids and conjunctive. A pulsating tumor develops at the margin of the 

 orbit, with thrill and the characteristic bruit; accompanying these symptoms there may be 

 impairment of the sight, paralysis of the iris and orbital muscles, and pain of varying intensity. 

 In some cases the opposite orbit becomes affected by the passage of the arterial blood into the 

 opposite sinus by means of the circular sinus. Or the arterial blood may find its way through 

 the emissary veins into the pterygoid plexus, and thence into the veins of the face. Pulsating 



CAVERNOUS 

 SINUS 



INFERIOR 

 OPHTHALMIC 



FIG. 506. Veins of the orbit. (Poirier and Charpy.) 



tumors of the orbit may also be due to traumatic aneurism of one of the orbital arteries, and 

 symptoms resembling those of pulsating tumor may be produced by pressure on the ophthalmic 

 vein, as it enters the sinus, by an aneurism of the internal carotid artery. Ligation of the internal 

 or the common carotid artery has been performed in these cases with some degree of success. 



Of recent years more attention has been paid to thrombosis of the cavernous sinus than for- 

 merly, and it is now well established that caries in the upper parts of the nasal fossa* and sup- 



