Section: USMLE

27) A 46-year-old man sustains a spider bite on his upper eyelid, and an infection develops. The physician is very concerned about spread of the infection to the dural venous sinuses of the brain via emissary veins. With which of the following dural venous sinuses does the superior ophthalmic vein directly communicate?

1. Cavernous sinus
2. Superior petrosal sinus
3. Occipital sinus
4. Sigmoid sinus
5. Straight sinus

The anterior continuation of the cavernous sinus, the superior ophthalmic vein, passes through the superior orbital fissure to enter the orbit. Veins of the face communicate with the superior ophthalmic vein. Because of the absence of valves in emissary veins, venous flow may occur in either direction. Cutaneous infections may be carried into the cavernous sinus and result in a cavernous sinus infection, which may lead to an infected cavernous sinus thrombosis. The cavernous sinus is lateral to the pituitary gland and contains portions of cranial nerves III, IV, V1, V2 and VI, and the internal carotid artery.

The occipital sinus is at the base of the falx cerebelli in the posterior cranial fossa. It drains into the confluence of sinuses.

The sigmoid sinus is the anterior continuation of the transverse sinus in the middle cranial fossa. The sigmoid sinus passes through the jugular foramen and drains into the internal jugular vein.

The straight sinus is at the intersection of the falx cerebri and the falx cerebelli in the posterior cranial fossa. The straight sinus connects the inferior sagittal sinus with the confluence of sinuses.

The superior petrosal sinus is at the apex of the petrous portion of the temporal bone and is a posterior continuation of the cavernous sinus. The superior petrosal sinus connects the cavernous sinus with the sigmoid sinus.