The apex of the orbit is basically formed by the optic canal, the superior orbital fissure, and their contents. Space-occupying lesions in this area can result in clinical deficits caused by compression of the optic nerve or extraocular muscles. Evenvascular changes in the cavernous sinus can produce a direct mass effect and affect the orbitapex. When pathologic changes in this region is suspected, contrast-enhanced MR imaging with fat saturation is very useful. According to the anatomic regions from which the lesions arise, they can be classified as belonging to one of five groups; lesions of the optic nerve-sheath complex, of the conal and intraconal spaces, of the extraconal space and bony orbit, of the cavernous sinus or diffuse. The characteristic MR findings of various orbital lesions will be described in this paper.
Cavernous Sinus ; Magnetic Resonance Imaging* ; Muscles ; Optic Nerve ; Orbit* ; Pathology*

Extracerebral cavernous hemangioma typically occurs in cavernous sinus in middle cranial fossa,showing iso-or hypointensity on T1WI,obvious hyperintensity on T2WI,and evident enhancement after contrast administration during magnetic resonance imaging(MRI).In this article we report one case of atypical cavernous hemangioma of the trigeminal nerve,with atypical MRI findings including isotense or slight long T2 signal,dotty short T1 signal,and non-enhancement on T1WI.
Cavernous Sinus ; diagnostic imaging ; Hemangioma, Cavernous ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Trigeminal Nerve ; pathology

Rhinocerebral mucormycosis is a very rare, but mostly fatal fungal infection, usually found in diabetic or other immunocompromised hosts. It has a characteristic pattern of spread, invasion of vessel walls with subsequent local thrombotic infarction or direct invasion. But we found two cases contrast to these typical patterns of spread. Our cases initially originated in the nasal cavity and progressed to the cavernous sinus in usual manner, but after then, extended along the trigeminal nerve into the pons. MRI demonstrated the perineural spread, which was confirmed by pathology.
Cavernous Sinus ; Immunocompromised Host ; Infarction ; Magnetic Resonance Imaging ; Mucormycosis* ; Nasal Cavity ; Pathology ; Pons* ; Trigeminal Nerve

Rhinocerebral mucormycosis is a very rare, but mostly fatal fungal infection, usually found in diabetic or other immunocompromised hosts. It has a characteristic pattern of spread, invasion of vessel walls with subsequent local thrombotic infarction or direct invasion. But we found two cases contrast to these typical patterns of spread. Our cases initially originated in the nasal cavity and progressed to the cavernous sinus in usual manner, but after then, extended along the trigeminal nerve into the pons. MRI demonstrated the perineural spread, which was confirmed by pathology.
Cavernous Sinus ; Immunocompromised Host ; Infarction ; Magnetic Resonance Imaging ; Mucormycosis* ; Nasal Cavity ; Pathology ; Pons* ; Trigeminal Nerve

Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient's headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.
Adult ; Cavernous Sinus/*pathology/*surgery ; Endoscopy/*methods ; Epidermal Cyst/*pathology/*surgery ; Humans ; Male ; Microsurgery/*methods ; Young Adult

This report documents the treatment of a giant aneurysm of the internal carotid artery bifurcation with a fistula to the cavernous sinus, which appeared following closed head trauma. A 39-year-old man suffered from a blunt head trauma in an automobile accident. Two weeks after the trauma, progressive chemosis of left eye was presented. Four months after the trauma, digital subtraction angiography showed an internal carotid artery bifurcation aneurysm, with drainage into the cavernous sinus. The lesion was successfully obliterated with preservation of the parent artery by using coils in conjunction with Onyx. Follow-up angiography obtained 3 months postoperatively revealed persistent obliteration of the aneurysm and fistula as well as patency of the parent artery. Endovascular treatment involving the use of coils combined with Onyx appears to be a feasible and effective option for treatment of this hard-to-treat lesion.
Adult ; Carotid Artery Diseases ; diagnosis ; therapy ; Carotid Artery, Internal ; Cavernous Sinus ; pathology ; Drainage ; Humans ; Intracranial Aneurysm ; diagnosis ; etiology ; Male

Teratomas represent 0.5% of all intracranial tumors. These benign tumors contain tissue representative of the three germinal layers. Most teratomas are midline tumors located predominantly in the sellar and pineal regions. The presence of a teratoma in the cavernous sinus is very rare. Congenital teratomas are also rare, especially those of a cystic nature. To our knowledge, this would be the first case report of a congenital, rapidly growing cystic teratoma within the cavernous sinus. A three-month-old boy presented with a past medical history of easy irritability and poor oral intake. A magnetic resonance image (MRI) scan of the head disclosed a large expanding cystic tumor filling the right cavernous sinus and extending into the pterygopalatine fossa through the foramen rotundum. These scans also demonstrated a small area of mixed signal intensity, the result of the different tissue types conforming to the tumor. Heterogeneous enhancement was seen after the infusion of contrast medium. However, this was a cystic tumor with a large cystic portion. Thus, a presumptive diagnosis of cystic glioma was made. With the use of a right frontotemporal approach, extradural dissection of the tumor was performed. The lesion entirely occupied the cavernous sinus, medially displacing the Gasserian ganglion and trigeminal branches (predominantly V1 and V2). The lesion was composed of different tissues, including fat, muscle and mature, brain-like tissue. The tumor was completely removed, and the pathological report confirmed the diagnosis of a mature teratoma. There was no evidence of recurrence. Despite the location of the lesion in the cavernous sinus, total removal can be achieved with the use of standard microsurgical techniques.
Cavernous Sinus/*pathology ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Paranasal Sinus Neoplasms/*congenital/*diagnosis/surgery ; Teratoma/*congenital/*diagnosis ; Tomography, X-Ray Computed

OBJECTIVETo discuss the treatment strategy of invasive prolactinomas (IPs) involving the cavernous sinus.

METHODSData from 80 patients with IPs treated in our institutions were reviewed retrospectively. The criteria utilized included: (1) invasion of the cavernous sinus by tumor, corresponding to Grade III-IV according to the classification of Knosp; (2) serum prolactin level > 9.1 nmol/L; (3) clinical signs of hyperprolactinemia and mass effect. Among the 80 patients who met the criteria: 21 patients received bromocriptine as primary treatment (Group A); 21 patients initially received bromocriptine and then accepted microsurgery or irradiation (Group B); 38 patients had initially undergone transcranial or transsphenoidal microsurgery and then received bromocriptine or adjuvant radiotherapy (Group C). Eleven patients underwent gamma knife radiotherapy.

RESULTSIn 57 patients (12 cases of Group A, 16 cases of Group B, 29 cases of Group C), the tumors on MRI had almost completely disappeared after an average follow-up period of 62 months, and in the other 23 patients, residual tumor involved the cavernous sinus. Visual symptoms improved in 33 patients while deteriorated in 7 patients. Serum prolactin level of 52 patients had in normal range after treatment (10 cases of Group A, 11 cases of Group B, 31 cases of Group C) and 7 patients were more than 9.1 nmol/L. Nine patients had symptoms of hypopituitarism.

CONCLUSIONSFor IPs, individualized treatment methods are advocated in which dopamine agonist medications are effective as first-line therapy. It is necessary to take dopamine agonist after operation and close observation is mandatory. Gamma knife surgery is an option to treat the residual tumor involving the cavernous sinus.

Adolescent ; Adult ; Aged ; Cavernous Sinus ; pathology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pituitary Neoplasms ; pathology ; therapy ; Prolactinoma ; pathology ; therapy ; Retrospective Studies ; Young Adult

BACKGROUNDSurgery of pituitary adenomas invading cavernous sinus has always been thought as a challenge due to the complex anatomical structures and high risk of complications. The purpose of this study was to evaluate endoscopic transsphenoidal approach to pituitary adenomas invading cavernous sinus.

METHODSThe clinical data of 22 patients who admitted to Xuanwu Hospital with pituitary adenomas invading cavernous sinus were analyzed retrospectively. All patients underwent endoscopic transsphenoidal surgery. To expose the surgical field sufficiently, the opening of sellar floor was exceeded the bone overlying the invaded cavernous sinus, and synthetic dura was used to repair and strengthen the sella floor for preventing the leak of cerebrospinal fluid.

RESULTSAmong 22 patients, total resection was achieved in 14, subtotal resection in 5, and partial resection in 3; no patient underwent insufficient resection. Visual symptoms improved in 7 of 9 patients. In one patient diplopia disappeared. Headache was relieved to various extents in all patients. No serious complications were found. Patient's hospital stay ranged from 7 to 20 days.

CONCLUSIONThese data suggest that the endoscopic transsphenoid approach is a safe, minimally invasive, and efficient surgical technique, which might be an important therapeutic strategy for the pituitary adenoms invading cavernous sinus.

Adenoma ; pathology ; surgery ; Adult ; Aged ; Cavernous Sinus ; pathology ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Neoplasm Invasiveness ; Pituitary Neoplasms ; pathology ; surgery ; Sphenoid Bone ; surgery

OBJECTIVETo study the effectiveness of treating giant pituitary adenomas invading cavernous sinus with neuroendoscopy assisted by multiple techniques.

METHODSA total of 72 patients who underwent neuroendoscopic surgery and 55 patients who underwent microscopic surgery for giant pituitary adenomas were enrolled in this retrospective analysis. Both groups received expanded endoscopic endonasal transsphenoidal approach, intraoperative application of navigation, and Doppler.The clinical data of two groups were compared.

RESULTSThe two groups were significantly different in total tumor removal rate, operation time, postoperative nasal patency, and postoperative recurrence rate (P=0.004, P=0.0003, P=0.000, and P=0.002, respectively), whereas the cerebrospinal fluid leakage, postoperative diabetes insipidus, and cranial nerve injury were not significantly different (P > 0.05).

CONCLUSIONSExpanded neuroendoscopic endonasal transsphenoidal approach assisted by multiple techniques is the preferred surgical method for giant invasive pituitary adenomas invading cavernous sinus.The lateral cavernous sinus approach and the further molecular biology research will bring more options for the treatment of invasive pituitary adenomas.

Adenoma ; pathology ; surgery ; Adult ; Aged ; Cavernous Sinus ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neuroendoscopy ; methods ; Pituitary Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome