The lateral sellar nerve plexus and its connections in humans

Object. The aim of the present study was to elucidate the systematic topography of the lateral sellar (cavernous sinus [CS]) nerve plexus and its connections in humans. Methods. Seven specimens of human CS and adjacent regions were dissected in steps and stained as whole-mount preparations by using a sensitive acetylcholinesterase method. Another specimen was frozen, cut on a frontal plane, and stained for acetylcholinesterase. The human CS contains an extensive nerve plexus with small ganglia. The plexus is composed of a main part, the lateral sellar plexus proper, which is located around the abducent nerve and medial to the ophthalmic nerve, and a lateral extension just underneath the outermost layer of the lateral CS wall, which is located lateral to the trochlear and ophthalmic nerves. The lateral sellar plexus is connected to the internal carotid nerve, the pterygopalatine ganglion, and the trigeminal ganglion. From the lateral sellar plexus, nerve branches run along the oculomotor, trochlear, ophthalmic, and abducent nerves into the orbit. In addition, the lateral sellar plexus has multiple connections with nerves located around the internal carotid artery. The presence of connections between the lateral sellar plexus and functionally defined neural structures suggests that the plexus receives sympathetic, parasympathetic, and sensory contributions. Conclusions. The plexus may distribute nerve subpopulations to several targets, including cerebral arteries and orbital structures. The presence of a mixed nerve plexus that projects to a variety of targets indicates that injury or disease in the CS may result in a variety of symptoms.