title: The cavernous sinus in cluster headache - a quantitative structural magnetic resonance imaging study.
abstract: Background It has been hypothesized that a constitutionally narrow cavernous sinus might predispose individuals to cluster headache. Cavernous sinus dimensions, however, have never been assessed. Methods In this case-control study, we measured the dimensions of the cavernous sinus, skull base, internal carotid and pituitary gland with high-resolution T2-weighted magnetic resonance imaging in 25 episodic, 24 chronic and 13 probable cluster headache patients, 8 chronic paroxysmal hemicrania patients and 22 headache-free controls. Dimensions were compared between groups, correcting for age, sex and transcranial diameter. Results On qualitative inspection, no relevant pathology or anatomic variants that were previously associated with cluster headache or chronic paroxysmal hemicranias were observed in the cavernous sinus or paracavernous structures. The left-to-right transcranial diameter at the temporal fossa level (mean ± SD) was larger in the headache groups (episodic cluster headache: 147.5 ± 7.3 mm, p = 0.044; chronic cluster headache: 150.2 ± 7.3 mm, p < 0.001; probable cluster headache: 146.0 ± 5.3 mm, p = 0.012; and chronic paroxysmal hemicrania: 145.2 ± 9.4 mm, p = 0.044) compared with controls (140.2 ± 8.0 mm). After adjusting for transcranial diameter and correcting for multiple comparisons, there were no differences in the dimensions of the cavernous sinus and surrounding structures between headache patients and controls. Conclusion Patients with cluster headache or chronic paroxysmal hemicrania had wider skulls than headache-free controls, but the proportional dimensions of the cavernous sinus were similar.
authors.affiliation: 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Enrico B
authors.initials: EB
authors.lastname: Arkink
authors.affiliation: 2 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.|3 Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Guus G
authors.initials: GG
authors.lastname: Schoonman
authors.affiliation: 2 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.|4 Department of Neurology, Slingeland Hospital, Doetinchem, The Netherlands.
authors.forename: Jorine A
authors.initials: JA
authors.lastname: van Vliet
authors.affiliation: 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Hannah S
authors.initials: HS
authors.lastname: Bakels
authors.affiliation: 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marjolein Am
authors.initials: MA
authors.lastname: Sneeboer
authors.affiliation: 2 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.|5 Department of Neurology, Alrijne Hospital, Leiderdorp, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Haan
authors.affiliation: 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Mark A
authors.initials: MA
authors.lastname: van Buchem
authors.affiliation: 2 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Michel D
authors.initials: MD
authors.lastname: Ferrari
authors.affiliation: 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Kruit
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002426:Cavernous Sinus / Q000473:pathology*; D003027:Cluster Headache / Q000473:pathology*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged
keywords: Cluster headache; cavernous sinus; chronic paroxysmal hemicrania