These may be metastatic from lung, breast, prostate, etc, result from local spread nasopharyngeal, pituitary, craniopharyngioma. A wide range of conditions can cause cavernous sinus syndrome, including neoplasms, infection, inflammation, and. Theisen, michael podell, theresa schneider, david a. The fissure and the anterior cavernous sinus contain the same structures, and determining which is involved in the absence of orbital mass signs is dependent on imaging. These signs and symptoms result from the involvement of the. Sampling was performed from the anterior, middle, and posterior parts of the cs, inferior petrosal sinus ips, and the peripheral vein. Owing to the fact that there are no valves in the sinus and its connected veins, the direction of blood flow is dependent on venous pressure. Imaging lesions of the cavernous sinus american journal of. Fenner cavernous sinus syndrome css is characterized by deficits in more than one of the cranial nerves cn that traverse the cavernous sinus at the base of the cranial vault. We report the case of a 53yearold man with a history of daily stabbing headache associated with. A 67yearold white man presented, in 2010, with 6 weeks of double vision and leftsided periorbital pain with altered sensation. To characterize lesions causing cavernous sinus syndrome.
Syndromes of the orbital fissure, cavernous sinus, cerebello. A retrospective study of cavernous sinus syndrome in 4 dogs and 8 cats sharon k. Cavernous sinus syndrome css is a condition characterized by multiple cranial nerve palsies manifesting with ophthalmoplegia, ptosis, and facial sensory loss due to involvement of adjacent cranial nerves. Cavernous sinus syndrome is characterized by lesions that affect multiple cranial nerves within the cavernous sinus.
Cavernous sinus syndrome css is a rare condition characterised by ophthalmoplegia, proptosis, ocular and conjunctival congestion, trigeminal sensory loss and horners syndrome. Sympathetic fibres join the abducens nerve for a short distance and thus a horners syndrome in conjunction with 6th nerve palsy is of precise localising value. Despite the development of the microsurgical technique in the seventies, it was thought that microneurosurgery was reaching its. Tumors, trauma, and vascular, infectious, and noninfectious inflammatory disorders have all been described as causes. Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus.
A case report of cavernous sinus syndrome in a patient. Cavernous sinus syndrome caused by a primary paranasal sinus nonhodgkins lymphoma. Cavernous sinus tumours are the most common cause of the cavernous sinus syndrome. Refers to a cavernoussinus syndrome caused by an idiopathic inflammatory lesion, an abnormal autoimmune response, or tumorsmetastases in the area of the cavernous sinus. Departmental guidelines anatomy cavernous sinus 2cm in length, height of 1cm paired venous sinus, on either side of body of sphenoid. The most common surgical approaches involve some variation of the standard frontotemporal craniotomy.
Observe the cavernous sinus blue, cranial nerves yellow and arteries red. In 1965 dwight parkinson 1 was the first to realize an anatomical study and to propose a surgical approach to the cavernous sinus. Traversed by numerous trabeculae, dividing it into a several caverns spaces, hence cavernous sinus relations. Cavernous sinus syndrome and headache due to bilateral. Cavernous sinus syndrome is a medical emergency, requiring prompt medical. Request pdf cavernous sinus syndrome the progress in the understanding of central nervous system cns and skull base infections, is tremendous and it is more so in the case of fungal. Cavernous sinus syndrome may result from mass effect of these tumors and cause ophthalmoplegia from compression of the oculomotor nerve, trochlear nerve, and abducens nerve. The tolosahunt syndrome ths is caused by a granulomatous inflammatory process that involves the anterior cavernous sinussuperior orbital fissure region, and is diagnosed by. The cause of cavernous sinus thrombosis is usually an infection. The three main branches of the meningohypophyseal trunk were the tentorial artery, present in 100%, the dorsal meningeal 90%, and the inferior hypophyseal 80%.
Cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. In cavernous sinus thrombosis, a blood clot blocks a vein that runs through a hollow space underneath the brain and behind the eye sockets. Its marked by a blood clot behind your eyes or at the base of your skull. For the first time, we report the use of bilateral cavernous sinus sampling before and. The technique of choice for study is mri, although ct can help recognize and identify some anomalies, such as bone destruction. Nothing demonstrates the limits of anatomical plasticity quite like pathology. What better way to show all available cavernous sinus connections than a highpressure cavernous sinus state, exemplified by the various complex and challenging fistulas which afflict it. The symptoms and signs of cavernous sinus disease are ophthalmoplegia, orbital congestion and proptosis, trigeminal sensory loss, and sympathetic disturbance. The impact of cavernous sinus drainage pattern on the results. Cavernous sinus syndrome as the initial presentation of.
Most cases occuring cavernous sinus syndrome develop in adults and pediatric cases are rare. A case report chengshu chang 1, w eiliang chen 2, chient e li 3, and paoy u w ang 4 abstract neurosarcoidosis, rare in patients with. A retrospective study of cavernous sinus syndrome in 4. The first page of the pdf of this article appears above. An abnormally growing pituitary adenoma, sitting on the bony sella turcica, will expand in the direction of least resistance and eventually compress the cavernous sinus. Case report cavernous sinus syndrome in a patient with. Two years previously, a fall had resulted in the fracture of her arm, and weeks later, she began to develop pain and swelling in the right eye, followed by numbness of the right. A cavernous sinus mass has a wide differential including. We report the case of a 53yearold man with a history of daily stabbing headache associated.
Jul 16, 2018 cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. Potential causes of cavernous sinus syndrome include metastatic tumors, direct extension of nasopharyngeal tumours, meningioma, pituitary tumors or pituitary apoplexy, aneurysms of the intracavernous carotid artery, carotidcavernous fistula, bacterial infection causing cavernous sinus thrombosis, aseptic cavernous sinus thrombosis, idiopathic granulomatous disease tolosahunt syndrome, and fungal infections. Orbital apex syndrome oas involves cranial neuropathies in association with optic nerve dysfunction. The progress in the understanding of central nervous system cns and skull base infections, is tremendous and it is more so in the case of fungal infections of cns and skull base, especially cavernous sinus cs fungal infection. Previous studies of cavernous sinus sampling css have been limited by technical factors 12, and have included only small numbers of patients 11, and only one patient with the ectopic acth syndrome has been evaluated in any of these studies. Parasellar syndrome cavernous sinus syndrome the cavernous sinus is a true dural venous sinus that is bordered by the temporal bone and the sphenoid bone, and lies lateral to the sella turcica. Most commonly the form is of septic cavernous sinus thrombosis.
The technique of choice for study is mri, although ct can help recognize and identify. In 5 patients with cushing syndrome, cavernous sinography was performed to assess drainage pattern of the cs. These malformations enlarge slowly and produce symptoms only in adult life. The clinical presentation typically consists of various combinations of ocular motor nerve impairments oculomotor nerve cn iii, trochlear nerve cn iv, and abducens nerve cn vi, horner syndrome, and sensory loss of the. These may be metastatic from lung, breast, prostate, etc, result from local spread nasopharyngeal, pituitary, craniopharyngioma, or be primary tumours meningioma, neurofibroma. An 89yearold woman with a history of hypertension and paget disease had a severe throbbing rightsided headache. Cavernous sinus syndrome cavernous sinus structure. The patient also tested positive for perinuclear antineutrophil cytoplasmic antibodies, suggesting the possibility of a vasculitic spectrum. The etiology of cavernous sinus syndrome css remains difficult to determine in spite of the development of neuroimaging techniques. The cavernous sinus is an unconventional venous system in the sense that it does not have a unidirectional flow of blood.
These signs and symptoms result from the involvement of the cranial nerves passing through the cavernous sinus. Cavernous sinus syndrome css refers to deficits in more than one of the cranial nerves iii, iv, v, and vi, as they are in close association in this region. These veins carry blood from the face and head back to the heart. Cavernous sinus thrombosis an overview sciencedirect. Imaging lesions of the cavernous sinus american journal. Cavernous sinus syndrome produced by communication between.
Endovascular treatment strategy for direct carotidcavernous fistulas resulting from rupture of intracavernous carotid aneurysms. Symptoms most commonly occur at the beginning of the fifth decade of life and include chronic and severe often unilateral headache often preceding ophthalmoplegia. There was an incomplete third nerve palsy and altered sensation in the first and second trigeminal dermatomes. Cavernous sinus syndrome with pachymeningitis practical. Cavernous sinus syndrome definition of cavernous sinus. Cavernous sinus syndrome css refers to deficits in more than.
Patients with cavernous sinus syndrome will have ophthalmoplegia, proptosis, chemosis, horner syndrome, and ophthalmic and maxillary trigeminal sensory loss. The distinction is the precise anatomic involvement of the disease process. The lesions of vascular etiology, being the most common cause aneurysms, are another. Paired venous sinus, on either side of body of sphenoid. Orbital apex syndrome is symptomatically related to superior orbital fissure syndrome and cavernous sinus syndrome with similar etiologies. Review of 26 years of personal experience in a large city hospital. Mar 22, 2018 cavernous sinus thrombosis is a potentially lifethreatening condition that can happen after an infection in your head. There are numerous diseases evoking cavernous sinus syndrome. The cavernous sinus contents structures within the sinus proper and also in its lateral wall and their relative positions can be recalled with the following mnemonic.
It is divided by septa into small caves from which it gets its name. Cavernous sinus thrombosis an overview sciencedirect topics. The impact of cavernous sinus drainage pattern on the. Cavernous sinus syndrome describes symptoms comprising ophthalmoplegia, chemosis, proptosis, horner syndrome, andor trigeminal sensory loss evoked by vascular, inflammatory, traumatic, congenital, or neoplastic processes affecting the cavernous sinus near the midline of the frontotemporal part at the base of the skull.
Ruptured cavernous sinus aneurysms causing carotid cavernous fistula. This is a rare disorder and can be of two typesseptic cavernous thrombosis and aseptic cavernous thrombosis. Malignant lymphoma 5,6 and trosahunt syndrome 79 were occasionally reported as diseases causing cavernous sinus syndrome in children. Coronal plane schematic drawing of the cavernous sinus and parasellar regions anatomy. Diagnosis may be difficult when there is no associated bruit. A malignant melanoma had been excised from his right forearm in 2003, with negative sentinel axial lymph node biopsy.
The oculomotor, trochlear, ophthalmic and maxillary divisions of the trigeminal nerve, and the abducens nerve run through the cavernous sinus, as does. Cavernous sinus thrombosis is a lifethreatening complication that may rarely result from infection spreading back through the emissary veins from the maxillary or nasal region, or upper teeth, or from infected thrombi in the anterior facial vein or less commonly the pterygoid plexus. O tom are the first letters of components of the lateral wall of cavernous sinus considered vertically, from the top to the bottom. Tumors, trauma, and vascular, infectious, and noninfectious inflammatory disorders have all.
The cavernous sinus is a paired dural venous sinus located within the cranial cavity. Sepsis dangerous area of face, paranasal sinuses, nasal cavities neurological severe pain eye anf forehead ophthalmic n. The dural sinuses are grouped into the sagittal, lateral including the transverse, sigmoid, and petrosal sinuses, and cavernous sinuses. Superior orbital fissure syndrome can be clinically indistinguishable from cavernous sinus syndrome and radiographic studies may be necessary to differentiate bone and hadley, 2005. The cavernous sinus cs is a paired venous sinus that runs along either side of the pituitary gland on the floor of the calvarium. Cavernous sinus syndrome is characterized by multiple cranial neuropathies. Broad categories of diseases involving the cavernous sinus can cause the socalled cavernous sinus syndrome. Cavernous sinus thrombosis is a very rare, lifethreatening condition that can affect adults and children in cavernous sinus thrombosis, a blood clot blocks a vein that runs through a hollow. Mar 21, 2020 cavernous sinus syndrome is a broad category of pathology that is often difficult to diagnose or define but can encompass damage to the ocular nerves andor the pupil, bloodshot conjunctiva, a reddening in parts of the face, changes in facial sweating, and other symptoms associated with horners syndrome. Tumors of the nasopharynx, skull base, and sphenoid sinus may extend to the cs as can perineural and hematogenous metastases. Cavernous sinus contents mnemonic radiology reference. Introduction in 1734, in a book named an anatomical exposition of the structure of the human body by james benignus winslow 16691770 began the first and only usage of the term cavernous sinus, thinking that it resembled corresponding author. Each cavernous sinus has a close anatomical relationship with several key structures in the head, and is arguably the most clinically important venous sinus in this article, we shall look at the anatomy of the cavernous sinus. Cavernous sinus syndromes refer to constellations of clinical signs and symptoms referable to pathology within or adjacent to the cavernous sinus.
Cavernous sinus syndrome radiology reference article. Pain can occur, especially with inflammatory processes. Cavernous sinus syndrome css is a rare and complicated disease that can be contributed to by neoplasms, vascular diseases, infections, miscellaneous inflammatory disorders, and other conditions. Cavernous sinus thrombosis cst is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. Cavernous sinus syndrome and systemic lupus erythematosus. Mar 27, 2015 cavernous sinus syndrome css is a rare condition characterised by ophthalmoplegia, proptosis, ocular and conjunctival congestion, trigeminal sensory loss and horners syndrome.
Among 151 patients, tumors 45 patients, 30% were the most frequent cause of cavernous sinus syndrome. We conducted the current study to identify clinical and imaging features that allow a reliable approach to the etiologic diagnosis of patients with css. Patients present with multiple unilateral cranial neuropathies involving any combination of the following. The most common are neurogenic tumors and cavernoma. Cavernous sinus syndrome select 5minute pediatrics topics. In addition, the ophthalmic and dorsal meningeal arteries arose from the carotid artery within the cavernous sinus in 8% and 6%, respectively. We describe a case of cushings disease presenting with the rare initial manifestation of metatarsal fracture, and the first published case of cavernous sinus syndrome likely secondary to venous infarction or cavernous sinus thrombosis and resulting in pituitary acthsecreting macroadenoma infarction complicating bipss cannulation. The clinical presentation includes impairment of ocular motor nerves, horners syndrome, and sensory loss of the first or second divisions of the trigeminal nerve in various combinations. Cavernous sinus neoplasms cavernous sinus tumors are the most common cause of cavernous sinus sindrome. A retrospective study of cavernous sinus syndrome in 4 dogs. Cavernous sinus syndrome can manifest with ophthalmoplegia, ptosis, exophthalmos, chemosis, vision loss, horner syndrome, facial pain, or headache. The clinical features of css can result from involvement of the cranial nerve, which passes through the cavernous sinus. However, when surgical causes 17 patients, 11% were included, trauma 36 patients, 24% became most common.
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