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Radiotherapy is an emerging treatment for hemangioma of the cavernous sinus because of its efficacy and safety in comparison with surgery. Recently, SRS showed favorable treatment results in patients with hemangioma of the cavernous sinus [12-14,18]. However, when performing radiosurgery on tumors located near the optic apparatus, radiation oncologists should be concerned about toxicities, especially those like radiation-induced optic neuropathy (RION). According to previous studies, the risk of radiation-related sequelae (for example, cranial nerve palsies) might be higher if the beneficial effects of fractionation are not used [10,19]. The risk of RION is the primary limitation of single-fraction SRS for many patients with parasellar lesions, such as cavernous sinus hemangioma. As part of the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) initiative, Mayo et al. [20] reviewed the available literature to determine the dose-volume relationship of RION. For single-fraction ...
We report a 12-year-old boy who presented with incomplete right ophthalmoplegia, exophthalmos and headache. Initial CT and MRI revealed a mass in the right cavernous sinus. During tumour work-up, CT i
Tolosa-Hunt Syndrome: Refers to a cavernous-sinus syndrome caused by an idiopathic inflammatory lesion, an abnormal autoimmune response, or tumors/metastases in the area of the cavernous sinus. Symptoms most commonly occur at the beginning of the fifth decade of life and include chronic and severe (often unilateral) headache often preceding ophthalmoplegia. Mild fever, double vision, exophthalmos, ptosis, vertigo, chronic fatigue, and arthralgia may occur. Steroids have been used successfully; however, spontaneous remission is common (except when caused by tumors/ metastases), as is recurrence. No sexual predilection has been reported. ...
The mass involves the left cavernous sinus, surrounds the carotid, and extends forward to the orbital apex, and backward to the tentorium and clivus.
The mass involves the left cavernous sinus, surrounds the carotid, and extends forward to the orbital apex, and backward to the tentorium and clivus.
The intercavernous sinuses (latin: sinus intercavernous) are dural venous sinuses that connect the right and left cavernous sinuses.
It is not always possible to tell if there is cavernous sinus invasion, but there are three signs to look out for: -Is there more than 50% encirclement of the carotid artery? Note: meningiomas tend to constrict the carotid artery, macroadenomas do not. -Is there lateral displacement of the lateral wall of the cavernous sinus compared to the opposite side? -Is there an increased amount of tissue interposed between the carotid artery and the lateral wall of the cavernous sinus? ...
Objectives: Upon completion of this conference the resident/student should be able to:. Describe the syndromes associated with cavernous sinus including:. ...
The illustration presents the cranial nerves within the cavernous sinus, their relationship to the pituitary gland, vascular structures and dural boundaries through both lateral view and coronal section. The trajectory change of the cranial nerve IV before going through the superior fissure was specifically addressed, which was oftentimes overlooked. Using DICOM data enables more accurate visualization of the sagittal cut of the sphenoid bone at the superior fissure, where harbors the complexity of vascular and neural structures. An overview of the skull with brain, cavernous sinus and internal carotid artery layered in, is also portrayed for orientation purposes. ...
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Of all pituitary adenomas, 6%-10% involve the cavernous sinus and are considered to be invasive. The clinical signs occur late. Cavernous sinus invasion increases the morbidity and mortality associated with surgical procedures. During MR imaging, the absence of invasion can be assumed if a venous compartment is visible between the tumour and the intracavernous internal cerebral artery (ICA).The content of the cavernous sinus is isointense and is interspersed with small foci of an increased signal intensity which correspond to a slow blood flow or the presence of fat; the ICA is easly identifiable because of its characteristic thin walls surrounding a lumen of a low signal intensity, which is reflective of a high-velocity flow void. After adminstration of a gadolinium contrast, the venous compartments are enhanced strongly, and, thus, the depiction of these structures becomes easy. On the other hand, total encasement of the intracavernous ICA is a very specific sign. Alternative criteria have to ...
Aneurysms arising from the intracavernous portion of the internal carotid artery very rarely rupture. A patient is presented in whom rupture of an aneurysm wholly within the cavernous sinus caused a subarachnoid hemorrhage. The aneurysm was successfu
... Nancy Huynh Ophthalmic Medical Technology UAMS, College of Health Professions Little Rock, AR Case Report A 48 year-old white... ...
Question - Have high BP, hypothyroid, aravhnoid cyst with small meningioma at the cavernous sinus. Is it safe to conceive?. Ask a Doctor about diagnosis, treatment and medication for Hypertension, Ask a General & Family Physician
The use of intravenous radio isotope angiography in 3 cases of unilateral carotid cavernous sinus fistula is described. The lesion gives a characteristic image pattern distinguishable from that of arteriovenous malformation ...
TY - JOUR. T1 - Imaging of the pituitary. AU - Ouyang, Tao. AU - Rothfus, William E.. AU - Ng, Jason M.. AU - Challinor, Sue M.. PY - 2011/5. Y1 - 2011/5. N2 - In the appropriate clinical setting of pituitary hyperfunction or hypofunction, visual field deficit, or cranial nerve palsy, imaging of the pituitary is necessary. This article reviews the normal appearance of the pituitary and its surroundings, emphasizing magnetic resonance imaging. Typical and variant appearances of pituitary pathology are discussed. Because growth of adenoma into surrounding structures is important to surgical management, cavernous sinus invasion and suprasellar spread as well as adenoma mimics are illustrated. Typical examples of pituitary dysfunction from other entities that secondarily affect the gland, hypophysis, or third ventricle are discussed. Some common errors of interpretation are listed.. AB - In the appropriate clinical setting of pituitary hyperfunction or hypofunction, visual field deficit, or cranial ...
The granulation pattern of somatotroph adenomas is well known to be associated with differing clinical and biochemical characteristics, and it has been shown that sparsely granulated tumours respond poorly to commonly used somatostatin receptor ligands (SRLs). We report a challenging case of acromegaly with a sparsely granulated tumour resistant to multiple modalities of treatment, ultimately achieving biochemical control with pasireotide. A 26-year-old lady presented with classical features of acromegaly, which was confirmed by an oral glucose tolerance test. Insulin-like growth factor 1 (IGF1) was 1710 µg/L (103-310 µg/L) and mean growth hormone (GH) was ,600 U/L. MRI scan showed a 4 cm pituitary macroadenoma with suprasellar extension and right-sided cavernous sinus invasion. She underwent trans-sphenoidal pituitary surgery. Histology displayed moderate amounts of sparsely granular eosinophilic cytoplasm, staining only for GH. Postoperative investigations showed uncontrolled disease ...
The granulation pattern of somatotroph adenomas is well known to be associated with differing clinical and biochemical characteristics, and it has been shown that sparsely granulated tumours respond poorly to commonly used somatostatin receptor ligands (SRLs). We report a challenging case of acromegaly with a sparsely granulated tumour resistant to multiple modalities of treatment, ultimately achieving biochemical control with pasireotide. A 26-year-old lady presented with classical features of acromegaly, which was confirmed by an oral glucose tolerance test. Insulin-like growth factor 1 (IGF1) was 1710 µg/L (103-310 µg/L) and mean growth hormone (GH) was ,600 U/L. MRI scan showed a 4 cm pituitary macroadenoma with suprasellar extension and right-sided cavernous sinus invasion. She underwent trans-sphenoidal pituitary surgery. Histology displayed moderate amounts of sparsely granular eosinophilic cytoplasm, staining only for GH. Postoperative investigations showed uncontrolled disease ...
A 67-year-old woman was admitted for retro-orbital and periorbital pain, increasing over 1 week and accompanied by progressive exophthalmia and palpebral ptosis on the left side. She was being treated for lung cancer metastasized to the liver and cerebellum. Physical examination revealed a complete ptosis of the left eyelid and complete absence of extraocular movements of the left eye, referable to the third, fourth and sixth cranial nerve. Head computed tomography (CT) showed mucous thickening of the left sphenoid and maxillary sinuses. Brain MRI revealed an expansive lesion involving the left cavernous sinus (Figure 1), which proved to be a new occurrence by comparison with a contrast-enhanced CT performed several weeks earlier. The lesion in the cavernous sinus appeared to be inseparable from T2-hypointense changes in the posterior part of the left sphenoid sinus (Figure 2a,b), whereas the remaining wall thickening of the ethmoidal, sphenoid and maxillary sinuses appeared to be smooth and ...
MRI studies revealed a mass in the perisella region which extended into the sella eroding the posterior sella floor. The mass extended from the superior orbital fissue to the tentorial margin and involved the optic chiasm and extended laterally to involve the right cavernous sinus, surrounding the right internal carotid artery ...
The world sinus literally means narrow passage. But in common medical knowledge of people it means the sinus cavities present in the facial region or some kind
To our knowledge, asymmetry of pituitary enhancement on dynamic MR images has not been mentioned as a feature of cavernous sinus AVF in the previous literature. No abnormality was detected on the routine (nondynamic) pre- and postcontrast MR images, other than a decrease in size after successful therapy. No pituitary dysfunction was noted, probably because of the localized venous congestion in the pituitary gland. The finding of delayed enhancement itself may not have clinical importance, as no pituitary dysfunction was noted. However, neuroradiologists and interventional neuroradiologists should be aware of this phenomenon in patients with a dural AVF in the cavernous sinus. Although we are aware of no report regarding pituitary dysfunction caused by the venous congestion, long-term exposure to the congestion or acute progression of the congestion could theoretically cause a functional disorder or hemorrhage of the pituitary gland, as seen in the venous congestion of the brain.. The unique ...
In text authors note they documented 4 cases of internal carotid stenosis (cavernous sinus meningioma n=2, pituitary adenoma n=2) at their institution; however, they dont say how many patients were treated. In this series, there were 49 cavernous sinus meningiomas reported, with mean margin dose 15.9 ...
Im hoping that someone can tell me anything everything they know about the CA ? Right now Ive been living a night mare with all of the worry, at this time Im awaiting for the Neruo to call me with my test results from a CTA I had done last Friday in Indy ...
The facial-cavernous anastomoses are the communications of the facial and deep facial veins with the cavernous sinus. Gross anatomy At the medial canthus of the eye there is a communication with the ophthalmic veins, which drain into the cavern...
In this article, OSullivan et al. describe the experience of the Cincinnati cranial base surgery team with regard to the management of 39 cavernous sinus (CS) meningiomas treated during 9 years (approximately four patients/yr). We agree on some points and disagree on most, based on our experience, published material, and material being prepared for publication. We have treated 114 meningiomas involving the CS at the University of Pittsburgh Medical Center and an additional 90 lesions at the George Washington University Medical Center(2).. 1) The authors are correct in their conclusion that some meningiomas involving the CS infiltrate the wall of the internal carotid artery (ICA) and infiltrate cranial nerves. The former was well established in a study by Shaffrey et al. (Shaffrey M, Dolenc V, unpublished data) and another study by our group (5). We see this repeatedly in the intracavernous ICA specimens that we send for pathological examination. The infiltration of cranial nerves by tumors was ...
... Let us first discover where it is located to know more about exactly what is cavernous sinus. The spacious sinus is called the la
This is the business view business. Ocular motor palsy occuring in association with other neurologic signs may be due to lesions in the brain stem, around the cavernous sinus, or in the eye ball. There are third, fourth, and sixth nerve paralysis, each type give different symptoms. In the t...
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... On-line free medical diagnosis assistant. Ranked list of possible diseases from either several symptoms or a full patient history. A similarity measure between symptoms and diseases is provided.
TY - JOUR. T1 - Cavernous sinus thrombosis. T2 - Current therapy. AU - Desa, Valmont P. AU - Green, Ryan. PY - 2012/9. Y1 - 2012/9. N2 - Cavernous sinus thrombosis represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. The prompt recognition and management of this problem is critical. However, most of the literature involves case-specific discussions. The purpose of this article was to review the literature and present current recommendations for the treatment of cavernous sinus thrombosis.. AB - Cavernous sinus thrombosis represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. The prompt recognition and management of this problem is critical. However, most of the literature involves case-specific discussions. The purpose of this article was to review the literature and present current recommendations for the treatment of cavernous sinus ...
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. The cause is usually from a spreading infection in the nose, sinuses, ears, or teeth. Staphylococcus aureus and Streptococcus are often the associated bacteria. Cavernous sinus thrombosis symptoms include: decrease or loss of vision, chemosis, exophthalmos (bulging eyes), headaches, and paralysis of the cranial nerves which course through the cavernous sinus. This infection is life-threatening and requires immediate treatment, which usually includes antibiotics and sometimes surgical drainage. The clinical presentation of CST can be varied. Both acute, fulminant disease and indolent, subacute presentations have been reported in the literature. The most common signs of CST are related to anatomical structures affected within the cavernous sinus, notably cranial nerves III-VI, as well as symptoms resulting ...
TY - JOUR. T1 - Iatrogenic carotid-cavernous fistula occurring after embolization of a cavernous sinus meningioma. AU - Barr, J. D.. AU - Mathis, J. M.. AU - Horton, J. A.. PY - 1995. Y1 - 1995. N2 - A carotid-cavernous fistula developed in a 62-year-old woman during an attempt at embolization of a skull base meningioma. The cause is thought to be perforation by the guide wire during catheterization of the meningohypophyseal trunk at the sharp bend at its origin.. AB - A carotid-cavernous fistula developed in a 62-year-old woman during an attempt at embolization of a skull base meningioma. The cause is thought to be perforation by the guide wire during catheterization of the meningohypophyseal trunk at the sharp bend at its origin.. KW - Catheters and catheterization, complications. KW - Iatrogenic disease or disorder. KW - Interventional neuroradiology, complications. UR - http://www.scopus.com/inward/record.url?scp=0028959447&partnerID=8YFLogxK. UR - ...
To investigate the relationship between cyclin B1 (CCNB1) gene expression and cavernous sinus invasion in pituitary adenomas. Twenty-four pituitary adenoma tissue samples were examined by RT-qPCR and Western blot to assess the mRNA expression levels and protein levels of CCNB1, E-cadherin and N-cadherin. Correlation analyses between the expression levels of E-cadherin, N-cadherin and CCNB1 were performed. After lentivirus-mediated knockdown of CCNB1 in rat pituitary adenoma cell lines (GH3 and GT1-1), cell function changes were studied. The relationship between CCNB1 and epithelial-mesenchymal transition (EMT) was further verified by animal experiments. CCNB1 and N-cadherin gene expression were significantly higher in the invasive pituitary adenomas than in the non-invasive pituitary adenomas. Conversely, E-cadherin expression in the invasive pituitary adenomas was significantly lower. CCNB1 gene expression was downregulated in the GH3 and GT1-1 pituitary adenoma cell lines; N-cadherin expression was
From The Apprentice Doctor, a video regarding Cavernous Sinus Thrombosis, which means a blood clot in the cavernous sinus. The cavernous sinus is in the base of the brain and contains several nerves, a vein and many other structures. The vein that sits in the Cavernous sinus carries deoxygenated blood from the brain & face and brings it back to the heart. This video shows how to spot Cavernous Sinus Thrombosis in a patients protruding eyes.
The pterygoid plexus (/ˈtɛrɪɡɔɪd/; from Greek pteryx, "wing" and eidos, "shape") is a venous plexus of considerable size, and is situated between the temporalis muscle and lateral pterygoid muscle, and partly between the two pterygoid muscles. It receives tributaries corresponding with the branches of the maxillary artery. Thus it receives the following veins: sphenopalatine middle meningeal deep temporal (anterior & posterior) pterygoid masseteric buccinator alveolar some palatine veins (palatine vein which divides into the greater and lesser palatine v.) a branch which communicates with the ophthalmic vein through the inferior orbital fissure infraorbital vein This plexus communicates freely with the anterior facial vein; it also communicates with the cavernous sinus, by branches through the foramen Vesalii, foramen ovale, and foramen lacerum. Due to its communication with the cavernous sinus, infection of the superficial face may spread to the cavernous sinus, causing cavernous sinus ...
Doctor answers on Symptoms, Diagnosis, Treatment, and More: Dr. Nguyen on cure cavernous sinus thrombosis: This is a situation where a large series of veins at the base of the skull, just behind the eyes clot off and block blood flow out of the brain. This can lead to a stroke, prominent eye(x) and it is a serious condition. for topic: Cure Cavernous Sinus Thrombosis
In a review of the worlds literature up to 1936 Cavenagh1 could find only a few reported recoveries from septic cavernous sinus thrombophlebitis. The septic type as described by Grove2 is that in which the thrombosis reaches the cavernous sinus by way of its afferent vessels. With the advent of the sulfonamides six other instances of recovery have been recorded.3, 4, 5, 6 Recently Nicholson and Anderson7 reported another case successfully treated by penicillin.. The case to be reported is of interest not only because of the recovery, but because it was successfully treated by a combination of sulfonamides and ...
Inflammatory changes in the cavernous sinus, superior orbital fissure, and/or orbital apex are typically observed on high-resolution contrast-enhanced imaging. These changes are not specific for Tolosa-Hunt syndrome and may also be present in neoplastic conditions of the cavernous sinus. Narrowing of the internal carotid artery within the cavernous sinus may be identified. ...
TY - JOUR. T1 - Endoscopic treatment of the isolated sphenoid sinus lesions. AU - Castelnuovo, Paolo. AU - Pagella, Fabio. AU - Semino, Lucia. AU - De Bernardi, Francesca. AU - Delù, Giovanni. PY - 2005/2. Y1 - 2005/2. N2 - Presenting symptoms of the isolated sphenoid sinus lesion are often vague and non-specific. Diagnostic nasal endoscopy procedures and imaging techniques are of great value for an early and precise diagnosis. Moreover, endoscopic sinus surgery is a safe and effective technique that allows a direct route to the sphenoid sinus. Because of its close vicinity to important and vulnerable structures of the skull base, delay in diagnosis and treatment can be potentially lethal. Endoscopically controlled procedures for the sphenoid sinus provide the surgeon with an obvious alternative to the traditional approaches. From November 1994 to May 2001 the authors operated on 41 patients with isolated sphenoid lesions. The pathology spectrum was rather wide and included 11 cases of isolated ...
We report the angiographic findings from six patients with intracranial dural arteriovenous fistulas of the inferior petrosal sinus and describe the clinical presentation, vascular anatomy, and embolization techniques used in the treatment of this disorder. Dural arteriovenous fistulas at this site are rare; of 105 patients diagnosed with this abnormality, only six had lesions involving the inferior petrosal sinus. The patients included three men and three women, ranging in age from 41 to 75 years. Patients presented with bruit, proptosis, abducens palsy, or loss of vision, and symptoms were present for up to 1 year prior to diagnosis. These presentations were similar to cavernous sinus arteriovenous fistulas. The arterial supply in all cases was from branches of the external carotid artery and in three cases from the meningohypophyseal trunk of the internal carotid artery. Venous drainage in four patients was via the cavernous sinus to the superior ophthalmic vein. The remaining two patients ...
Five days after surgery the patient developed a marked diplopia, pain in the eye and a third cranial nerve palsy. An urgent CT scan documented a minimal enlargement of the cavernous sinus lesion (not shown). Corticosteroid treatment was initiated and three weeks later there was complete resolution of both pain and cranial nerve palsy. Corticosteroids were subsequently tapered and discontinued. The patient underwent 3D-Conformal Radiation Therapy (3D-CRT) of the lesion of the cavernous sinus (total dose 5040 cGy with a daily dose of 180 cGy), with an initial tumour reduction. Three years later, due to a symptomatic growth, the patient underwent surgical debulking of the lesion with resolution of the pre-operative trigeminal neuralgia and persistence of third cranial nerve palsy. Histological examination of the lesion documented features similar to the previously resected lesion, with a proliferative index of 2 %.. He then received four cycles of adjuvant Temozolomide (150-200 mg/mq/die for 5 days ...
PurposeTSH-secreting pituitary adenomas are rare pituitary tumors. An efficient treatment is essential to limit the mortality and morbidity in untreated patients. The aim of this study is to summarize the evidence about the postoperative outcomes and management of this rare pathology.MethodsA systematic search and meta-analysis of surgical series was performed.ResultsOur analysis included 23 articles (536 patients). No sex difference was observed and mean age at diagnosis was 45years. Hyperthyroidism was reportedly clinical in 67% and biochemical in 90% of patients. Co-secretion of other pituitary hormones was present in 42% of cases. Macroadenomas were found in 79% of patients, showing in 44% and 30% of cases respectively extrasellar extension and cavernous sinus invasion. The pooled rate of postoperative biochemical remission was 69.7% and a gross total resection (GTR) was observed in 54% of patients. The extent of resection was significantly increased in microadenomas (p<0.001) and cavernous sinus
Carotid cavernous fistulas are abnormal communications between the carotid artery and the cavernous sinus, either directly or via intradural branches of the internal or external carotid arteries.1 Direct fistulas are high flow, frequently follow trauma, and tend to have a dramatic clinical presentation. In contrast, indirect fistulas are low flow, often spontaneous, and may have a subtle clinical presentation. Symptoms and signs common to both types of fistulas include proptosis, chemosis, diplopia, visual loss, pulse-synchronous tinnitus, orbital bruit, elevated intraocular pressure, dilated episcleral veins, and retinal venous congestion. The pattern of venous drainage, either anterior into the ophthalmic veins or posterior into the petrosal sinuses, often dictates the clinical findings and radiographic appearance. Anterior drainage typically leads to the most dramatic ocular findings and enlargement of the superior orbital vein, the latter often detectable with CT or MRI. However, superior ...
Background: Radiosurgery clinical practice relays on empirical observations and the experience of the practitioners involved in determining and delineating the target and therefore variability in target delineation might be expected for all the radiosurgery approaches, independent of the technique and the equipment used for delivering the treatment. The main aim of this study was to quantify the variability of target delineation for two radiosurgery targets expected to be difficult to delineate. The secondary aim was to investigate the dosimetric implications with respect to the plan conformity. The primary aim of the study has therefore a very general character, not being bound to one specific radiosurgery technique.. Materials and methods: Twenty radiosurgery centers were asked to delineate one cavernous sinus meningioma and one astrocytoma and to plan the treatments for Leksell Gamma Knife Perfexion. The analysis of the delineated targets was based on the calculated 50% agreement volume, ...
Superior orbital fissure syndrome information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis.
TY - JOUR. T1 - Cavernous sinus septic thrombosis. Case report. AU - Milano, F.. AU - Viale, P.. AU - Tinelli, M.. AU - Ghezzi, L.. AU - Maccabruni, A.. PY - 1989. Y1 - 1989. UR - http://www.scopus.com/inward/record.url?scp=0024723578&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=0024723578&partnerID=8YFLogxK. M3 - Article. C2 - 2595076. AN - SCOPUS:0024723578. VL - 80. SP - 463. EP - 465. JO - Recenti Progressi in Medicina. JF - Recenti Progressi in Medicina. SN - 0034-1193. IS - 9. ER - ...
TY - JOUR. T1 - Subgaleal retention sutures. T2 - Internal pressure dressing technique for Dolenc approach. AU - Burrows, Anthony M.. AU - Rayan, Tarek. AU - Van Gompel, Jamie. PY - 2017. Y1 - 2017. N2 - BACKGROUND: Extradural approach to the cavernous sinus, the "Dolenc"approach recognizing its developing Dr. Vinko Dolenc, is a critically important skull base approach. However, resection of the lateralwall of the cavernous sinus,most commonly for cavernous sinus meningiomas, results commonly in a defect that often cannot be reconstructed in a water-tight fashion. This may result in troublesome pseudomeningocele postoperatively. OBJECTIVE: To describe a technique designed to mitigate the development of pseudomeningocele. METHODS: We found the Dolenc approach critical for resection of cavernous lesions. However, a number of pseudomeningoceles were managed with prolonged external pressure wrapping in the early cohort. Therefore, we incorporated subgaleal to muscular sutures, which were designed to ...
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