Department of Ophthalmology, University of Alabama, School of Medicine, Birmingham.

Evaluation of over 255 patients with sellar and parasellar lesions allowed study of the computed tomographic (CT) appearance of the cavernous sinus. Optimal visualization of the cavernous sinus was obtained with continuous contrast enhancement of both axial and coronal tomograms. The coronal projection provided imaging of cranial nerves with the cavernous sinus. The intracavernous carotid artery was seen only if it were calcified or encased by tumor extending into or invading the sinus. CT criteria suggesting an abnormal cavernous sinus are: (1) asymmetry of size, (2) asymmetry of shape, particularly the lateral wall, and (3) focal areas of abnormal density within the sinus. The neurovascular anatomy of the cavernous sinus is reviewed and correlated with CT findings. Discrepancies between anatomic and CT appearance are discussed.