Cavernous sinus hemodynamic buffering model (CSHBM): a novel hypothesis for neurovascular protection

Abstract

The cavernous sinus (CS) is an anatomically complex venous plexus located at the base of the skull, closely associated with the internal carotid artery (ICA) and cranial nerves controlling ocular movement and facial sensation. We propose the Cavernous Sinus Hemodynamic Buffering Model (CSHBM), hypothesizing that the CS acts as a dynamic hemodynamic buffer protecting these vital neurovascular structures from the pulsatile forces generated by the ICA and external mechanical stresses. According to this model, the venous blood acts as a viscoelastic cushion, and together with the trabeculated architecture and compliant walls of the sinus, facilitates absorption, attenuation, and gradual dissipation of arterial pulsatile energy. This mechanism reduces mechanical strain on adjacent cranial nerves and preserves microvascular stability. The model underscores a potentially underappreciated neuroprotective role of the CS, particularly relevant in pathologies such as carotid-cavernous fistulas and thrombosis. This hypothesis can be evaluated using computational fluid dynamics (CFD), fluid–structure interaction (FSI) modeling, and advanced imaging modalities like 4D Flow MRI and phase-contrast MRI to assess pressure dynamics and flow modulation within the cavernous sinus. Understanding this buffering function may provide new insights into cavernous sinus pathophysiology and inform future diagnostic and therapeutic approaches.