Cavernous Sinus Syndrome

Cranial nerves are often involved in lesions of the cavernous sinuses, including the third, the fourth, the sixth, and the first two divisions of the fifth. The most commonly encountered lesions in this area are inflammatory diseases of unknown etiology, aneurysms of the subclinoid internal carotid artery (siphon), y carotid artery and dural branch-cavernous sinus fistula, y and tumors. Meningiomas of the medial sphenoid ridge and pituitary tumors expanding laterally from the sella can also involve the cranial nerves within the cavernous sinuses. U A mucocele of the sphenoid and ethmoid sinuses can, on rare occasions, present this way as well. y

Granulomatous or primarily lymphocytic inflammation in the cavernous sinus and superior orbital fissure is known as the Tolosa-Hunt syndrome .y , y It is manifest primarily by painful ophthalmoplegia and nearly always improves with steroid treatment. This relatively benign inflammatory disease must be distinguished, however, from other infiltrating lesions such as lymphomas, which may also respond transiently to steroid administration. An analysis of 108 patients with either benign lymphoid hyperplasia or malignant lymphoma revealed that there were no presenting or early clinical, laboratory, or tissue morphological features that reliably predicted the benign or malignant behavior of the lesion over the entire course of the illness. y

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