Cavernous sinus syndrome. Analysis of 151 cases
J. R. Keane
Department of Neurology, Los Angeles County/University of Southern California Medical Center, USA.
OBJECTIVE: To characterize lesions causing cavernous sinus syndrome.
DESIGN: Review of 26 years of personal experience in a large city hospital.
RESULTS: Among 151 patients, tumors (45 patients, 30%) were the most
frequent cause of cavernous sinus syndrome. However, when surgical causes
(17 patients, 11%) were included, trauma (36 patients, 24%) became most
common. Self-limited inflammation was the third frequent cause (34
patients, 23%), while carotid aneurysms and fistulas, infection, and other
causes composed the remaining 12%. The age at onset varied with the cause,
and patients with aneurysms (average age, 52 years) and patients with
tumors (average age, 47 years) were older than those with self-limited
inflammation (average age, 35 years) and trauma (average age, 29 years).
Spontaneous remissions defined "self-limited inflammation" but were also
seen following an acute onset of symptoms due to aneurysms and pituitary
apoplexy. CONCLUSIONS: In an unselected series from a city hospital, tumor,
trauma, and self-limited inflammation were the predominant causes of
cavernous sinus syndrome, and classic causes such as aneurysm, meningioma,
and bacterial infection were uncommon. Contrast-enhanced magnetic resonance
imaging and watchful waiting proved the most effective diagnostic
procedures.