There is a confluence in and around the cavernous sinus of neural pathways innervating the intracranial structures. To determine the patterns of innervation, particularly of the cerebral arteries, we stained whole-mount preparations of the cavernous sinus and adjacent regions of the rat for acetylcholinesterase. The cavernous nerve plexus, with several small ganglia, mainly occupied the lateral wall of the sinus and extended laterally above the ophthalmic and maxillary divisions of the trigeminal nerve, in relation to the oculomotor and trochlear nerves. The cavernous plexus was connected to the pterygopalatine ganglion, the trigeminal ganglion, and the abducens nerve. The elongated pterygopalatine ganglion consisted of an orbital part, from which parasympathetic fibers ran to the cerebral arteries, and a cavernous part. Nerves from the lateral extension of the cavernous plexus ran rostrally into the orbit along the oculomotor, trochlear, and ophthalmic nerves, and caudally to the pineal gland along the trochlear nerve. Several branches also ran over the dura mater. Caudal to the cavernous sinus, we found two large nerves and a number of small nerves that ran between the nerves surrounding the internal carotid artery and the abducens nerve. These nerves may represent additional parasympathetic and/or sensory pathways to the cerebral arteries.
ABSTRACT.Purpose: The HELIOS (Health Economics with Lucentis in Observational Settings) study was designed on request of the Dutch Health Authority for an observational study to assess the effectiveness and safety of ranibizumab for neovascular age-related macular degeneration (wet AMD) in daily practice. Methods: The HELIOS study was a 2-year prospective, observational, openlabel, multicentre study involving 14 sites. Patients with wet AMD were enrolled and observed for a period of 24 months. The data were collected at baseline and at the visits closest around the time-points 3, 6, 12, 18 and 24 months after inclusion. Results: Treatment with ranibizumab resulted in prevention of vision loss. The mean ETDRS score increased from 45.1 letters at baseline to 48.5 letters at 24 months. This was achieved with a mean of 7.8 injections over 24 months. Stabilization of visual acuity was also reflected by the scores on the quality of life EQ-5D questionnaire, which did not significantly change over the study period. The more subjective EQ-VAS questionnaire showed an overall improvement. The VFQ-25 questionnaire was also mostly stable over time. After 24 months, 32.2% of the patients gained ≥1 letter and 17.1% gained >15 letters. Patients completing the loading phase were better responders, as demonstrated by increased long-term visual acuity. In addition, ranibizumab was well tolerated and had a safety profile commonly seen in routine clinical practice. Conclusion: This study demonstrates that also in daily practice ranibizumab was effective in preventing vision loss over a period of 24 months. No new safety findings were identified.
There is a confluence in and around the cavernous sinus of neural pathways innervating the intracranial structures. To determine the patterns of innervation, particularly of the cerebral arteries, we stained whole-mount preparations of the cavernous sinus and adjacent regions of the rat for acetylcholinesterase. The cavernous nerve plexus, with several small ganglia, mainly occupied the lateral wall of the sinus and extended laterally above the ophthalmic and maxillary divisions of the trigeminal nerve, in relation to the oculomotor and trochlear nerves. The cavernous plexus was connected to the pterygopalatine ganglion, the trigeminal ganglion, and the abducens nerve. The elongated pterygopalatine ganglion consisted of an orbital part, from which parasympathetic fibers ran to the cerebral arteries, and a cavernous part. Nerves from the lateral extension of the cavernous plexus ran rostrally into the orbit along the oculomotor, trochlear, and ophthalmic nerves, and caudally to the pineal gland along the trochlear nerve. Several branches also ran over the dura mater. Caudal to the cavernous sinus, we found two large nerves and a number of small nerves that ran between the nerves surrounding the internal carotid artery and the abducens nerve. These nerves may represent additional parasympathetic and/or sensory pathways to the cerebral arteries.
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