Skip to main content
SpringerLink
Log in

Orbital Signs of Parasellar Syndromes

  • Chapter
  • First Online:
Smith and Nesi’s Ophthalmic Plastic and Reconstructive Surgery

Abstract

Retro-orbital pathology involving the parasellar region can cause signs and symptoms that can be mistaken for orbital disease. Patients can present with a combination of proptosis, eyelid edema and erythema, chemosis, vision loss, numbness, and ophthalmoplegia with or without pain. A retro-orbital process should be considered when ophthalmoplegia is more consistent with a cranial neuropathy affecting the oculomotor nerve (CN 3), trochlear nerve (CN 4), or abducens nerve (CN 6) rather than extraocular muscle limitation. They have been divided anatomically into the superior orbital fissure syndrome (SOFS), orbital apex syndrome (OAS), or cavernous sinus syndrome (CSS).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 259.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tubbs RS, Hill M, May WR, et al. Does the maxillary division of the trigeminal nerve traverse the cavernous sinus? An anatomical study and review of the literature. Surg Radiol Anat. 2008;30:37–40.

    Article  PubMed  Google Scholar 

  2. Fernández S, Godino O, Martínez-Yélamos S, Mesa E, Arruga J, Ramón JM, Acebes JJ, Rubio F. Cavernous sinus syndrome: a series of 126 patients. Medicine (Baltimore). 2007;86:278–81.

    Article  Google Scholar 

  3. Lin CC, Tsai JJ. Relationship between the number of involved cranial nerves and the percentage of lesions located in the cavernous sinus. Eur Neurol. 2003;49(2):98–102.

    Article  PubMed  Google Scholar 

  4. Kline LB. The Tolosa-Hunt syndrome. Surv Ophthalmol. 1982;27:79–95.

    Article  CAS  PubMed  Google Scholar 

  5. Thomas JE, Yoss RE. The parasellar syndrome: problems in determining etiology. Mayo Clin Proc. 1970;45:617–23.

    CAS  PubMed  Google Scholar 

  6. Keane JR. Cavernous sinus syndrome. Analysis of 151 cases. Arch Neurol. 1996;53:967–71.

    Article  CAS  PubMed  Google Scholar 

  7. Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 cases. Arch Ophthalmol. 1981;99:76–9.

    Article  CAS  PubMed  Google Scholar 

  8. Jefferson G. Concerning injuries, aneurysms and tumours involving the cavernous sinus. Trans Ophthalmol Soc U K. 1953;73:117–52.

    Google Scholar 

  9. Godtfredsen E, Lederman M. Diagnostic and prognostic roles of ophthalmoneurologic signs and symptoms in malignant nasopharyngeal tumors. Am J Ophthalmol. 1965;59:1063–9.

    CAS  PubMed  Google Scholar 

  10. Sibal L, Ball SG, Connolly V, et al. Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases. Pituitary. 2004;7:157–63.

    Article  PubMed  Google Scholar 

  11. Kalina P, Black K, Woldenberg R. Burkitt’s lymphoma of the skull base presenting as cavernous sinus syndrome in early childhood. Pediatr Radiol. 1996;26:416–7.

    Article  CAS  PubMed  Google Scholar 

  12. Rubin MM, Sanfilippo RJ. Lymphoma of the paranasal sinuses presenting as cavernous sinus syndrome. J Oral Maxillofac Surg. 1992;50:749–51.

    Article  CAS  PubMed  Google Scholar 

  13. Barrow DL, Spector RH, Braun IF, et al. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg. 1985;62:248–56.

    Article  CAS  PubMed  Google Scholar 

  14. Preechawat P, Narmkerd P, Jiarakongmun P, et al. Dural carotid cavernous sinus fistula: ocular characteristics, endovascular management and clinical outcome. J Med Assoc Thai. 2008;91:852–8.

    PubMed  Google Scholar 

  15. Oishi A, Miyamoto K, Yoshimura N. Etiology of carotid cavernous fistula in Japanese. Jpn J Ophthalmol. 2009;53:40–3.

    Article  PubMed  Google Scholar 

  16. Debrun GM, Viñuela F, Fox AJ, et al. Indications for treatment and classification of 132 carotid-cavernous fistulas. Neurosurgery. 1988;22:285–9.

    Article  CAS  PubMed  Google Scholar 

  17. Kirsch M, Henkes H, Liebig T, et al. Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients. Neuroradiology. 2006;48:486–90.

    Article  CAS  PubMed  Google Scholar 

  18. Meyers PM, Halbach VV, Dowd CF, et al. Dural carotid cavernous fistula: definitive endovascular management and long-term follow-up. Am J Ophthalmol. 2002;134:85–92.

    Article  PubMed  Google Scholar 

  19. Leonard TJ, Moseley IF, Sanders MD. Ophthalmoplegia in carotid cavernous sinus fistula. Br J Ophthalmol. 1984;68:128–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Chen CC, Chang PC, Shy CG, et al. CT angiography and MR angiography in the evaluation of carotid cavernous sinus fistula prior to embolization: a comparison of techniques. AJNR Am J Neuroradiol. 2005;26:2349–56.

    PubMed  Google Scholar 

  21. Halbach VV, Hieshima GB, Higashida RT, et al. Carotid cavernous fistulae: indications for urgent treatment. AJR Am J Roentgenol. 1987;149:587–93.

    Article  CAS  PubMed  Google Scholar 

  22. Halbach VV, Higashida RT, Hieshima GB, et al. Dural fistulas involving the cavernous sinus: results of treatment in 30 patients. Radiology. 1987;163:437–42.

    CAS  PubMed  Google Scholar 

  23. Higashida RT, Hieshima GB, Halbach VV, et al. Closure of carotid cavernous sinus fistulae by external compression of the carotid artery and jugular vein. Acta Radiol Suppl. 1986;369:580–3.

    CAS  PubMed  Google Scholar 

  24. Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg. 1974;41:125–45.

    Article  CAS  PubMed  Google Scholar 

  25. Lewis AI, Tomsick TA, Tew Jr JM, et al. Long-term results in direct carotid-cavernous fistulas after treatment with detachable balloons. J Neurosurg. 1996;84:400–4.

    Article  CAS  PubMed  Google Scholar 

  26. Debrun G, Lacour P, Vinuela F, et al. Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg. 1981;55:678–92.

    Article  CAS  PubMed  Google Scholar 

  27. Goldberg RA, Goldey SH, Duckwiler G, et al. Management of cavernous sinus-dural fistulas. Indications and techniques for primary embolization via the superior ophthalmic vein. Arch Ophthalmol. 1996;114:707–14.

    Article  CAS  PubMed  Google Scholar 

  28. Keltner JL, Satterfield D, Dublin AB, et al. Dural and carotid cavernous sinus fistulas. Diagnosis, management, and complications. Ophthalmology. 1987;94:1585–600.

    Article  CAS  PubMed  Google Scholar 

  29. Yoshida K, Melake M, Oishi H, et al. Transvenous embolization of dural carotid cavernous fistulas: a series of 44 consecutive patients. AJNR Am J Neuroradiol. 2010;31:651–5.

    Article  CAS  PubMed  Google Scholar 

  30. Morón FE, Klucznik RP, Mawad ME, et al. Endovascular treatment of high-flow carotid cavernous fistulas by stent-assisted coil placement. AJNR Am J Neuroradiol. 2005;26:1399–404.

    PubMed  Google Scholar 

  31. Archondakis E, Pero G, Valvassori L, et al. Angiographic follow-up of traumatic carotid cavernous fistulas treated with endovascular stent graft placement. AJNR Am J Neuroradiol. 2007;28:342–7.

    CAS  PubMed  Google Scholar 

  32. Wang C, Xie X, You C, et al. Placement of covered stents for the treatment of direct carotid cavernous fistulas. AJNR Am J Neuroradiol. 2009;30:1342–6.

    Article  CAS  PubMed  Google Scholar 

  33. Linskey ME, Sekhar LN, Hirsch Jr W, et al. Aneurysms of the intracavernous carotid artery: clinical presentation, radiographic features, and pathogenesis. Neurosurgery. 1990;26:71–9.

    Article  CAS  PubMed  Google Scholar 

  34. Kannoth S, Iyer R, Thomas SV, Furtado SV, Rajesh BJ, Kesavadas C, Radhakrishnan VV, Sarma PS. Intracranial infectious aneurysm: presentation, management and outcome. J Neurol Sci. 2007;256:3–9.

    Article  PubMed  Google Scholar 

  35. Wiebers DO, Whisnant JP, Huston 3rd J, For the International Study of Unruptured Intracranial Aneurysms Investigators, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362:103–10.

    Article  PubMed  Google Scholar 

  36. Kupersmith MJ, Stiebel-Kalish H, Huna-Baron R, et al. Cavernous carotid aneurysms rarely cause subarachnoid hemorrhage or major neurologic morbidity. J Stroke Cerebrovasc Dis. 2002;11:9–14.

    Article  PubMed  Google Scholar 

  37. Linskey ME, Sekhar LN, Hirsch Jr WL, et al. Aneurysms of the intracavernous carotid artery: natural history and indications for treatment. Neurosurgery. 1990;26:933–7.

    Article  CAS  PubMed  Google Scholar 

  38. Tolosa E. Periarteritic lesions of the carotid siphon with the clinical features of a carotid infraclinoidal aneurysm. J Neurol Neurosurg Psychiatry. 1954;17:300–2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Hunt WE, Meagher JN, Lefever HE, et al. Painful opthalmoplegia. Its relation to indolent inflammation of the carvernous sinus. Neurology. 1961;11:56–62.

    Article  CAS  PubMed  Google Scholar 

  40. Smith JL, Taxdal DS. Painful ophthalmoplegia. The Tolosa-Hunt syndrome. Am J Ophthalmol. 1966;61:1466–72.

    CAS  PubMed  Google Scholar 

  41. The International Classification of headache disorders. ICHD-II. Cephalalgia. 2004;24:131.

    Google Scholar 

  42. Hannerz J. Pain characteristics of painful ophthalmoplegia (the Tolosa-Hunt syndrome). Cephalalgia. 1985;5:103–6.

    Article  CAS  PubMed  Google Scholar 

  43. Gonzales GR. Pain in Tolosa-Hunt syndrome. J Pain Symptom Manage. 1998;16:199–204.

    Article  CAS  PubMed  Google Scholar 

  44. La Mantia L, Curone M, Rapoport AM, Bussone G. Tolosa-Hunt syndrome: critical literature review based on IHS 2004 criteria. International Headache Society. Cephalalgia. 2006;26(7):772–81.

    Article  PubMed  Google Scholar 

  45. Colnaghi S, Versino M, Marchioni E, et al. ICHD-II diagnostic criteria for Tolosa-Hunt syndrome in idiopathic inflammatory syndromes of the orbit and/or the cavernous sinus. Cephalalgia. 2008;28:577–84.

    Article  CAS  PubMed  Google Scholar 

  46. de Arcaya AA, Cerezal L, Canga A, et al. Neuroimaging diagnosis of Tolosa-Hunt syndrome: MRI contribution. Headache. 1999;39:321–5.

    Article  PubMed  Google Scholar 

  47. Muhletaler CA, Gerlock Jr AJ. Orbital venography in painful ophthalmoplegia (Tolosa-Hunt syndrome). AJR Am J Roentgenol. 1979;133:31–4.

    Article  CAS  PubMed  Google Scholar 

  48. Goto Y, Goto I, Hosokawa S. Neurological and radiological studies in painful ophthalmoplegia: Tolosa-Hunt syndrome and orbital pseudotumour. J Neurol. 1989;236:448–51.

    Article  CAS  PubMed  Google Scholar 

  49. Curone M, Tullo V, Proietti-Cecchini A, et al. Painful ophthalmoplegia: a retrospective study of 23 cases. Neurol Sci. 2009;30:S133–1355.

    Article  PubMed  Google Scholar 

  50. Haque TL, Miki Y, Kashii S, et al. Dynamic MR imaging in Tolosa-Hunt syndrome. Eur J Radiol. 2004;51:209–17.

    Article  PubMed  Google Scholar 

  51. Hannerz J, Ericson K, Bergstrand G. A new etiology for visual impairment and chronic headache. The Tolosa-Hunt syndrome may be only one manifestation of venous vasculitis. Cephalalgia. 1986;6:59–63.

    Article  CAS  PubMed  Google Scholar 

  52. Foubert-Samier A, Sibon I, Maire JP, et al. Long-term cure of Tolosa-Hunt syndrome after low-dose focal radiotherapy. Headache. 2005;45:389–91.

    Article  PubMed  Google Scholar 

  53. Mormont E, Laloux P, Vauthier J, et al. Radiotherapy in a case of Tolosa-Hunt syndrome. Cephalalgia. 2000;20:931–3.

    Article  CAS  PubMed  Google Scholar 

  54. Furukawa Y, Yamaguchi W, Ito K, et al. The efficacy of radiation monotherapy for Tolosa-Hunt syndrome. J Neurol. 2010;257:288–90.

    Article  PubMed  Google Scholar 

  55. Hatton MP, Rubin PA, Foster CS. Successful treatment of idiopathic orbital inflammation with mycophenolate mofetil. Am J Ophthalmol. 2005;140:916–8.

    Article  CAS  PubMed  Google Scholar 

  56. O’ Connor G, Hutchinson M. Tolosa-Hunt syndrome responsive to infliximab therapy. J Neurol. 2009;256:660–1.

    Article  PubMed  Google Scholar 

  57. Schafranski MD. Idiopathic orbital inflammatory disease successfully treated with rituximab. Clin Rheumatol. 2009;28:225–6.

    Article  PubMed  Google Scholar 

  58. Smith JR, Rosenbaum JT. A role for methotrexate in the management of non-infectious orbital inflammatory disease. Br J Ophthalmol. 2001;85:1220–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  59. Förderreuther S, Straube A. The criteria of the International Headache Society for Tolosa-Hunt syndrome need to be revised. J Neurol. 1999;246:371–7.

    Article  PubMed  Google Scholar 

  60. Grove WE. Septic and aseptic types of thrombosis of the cavernous sinus. Arch Otolaryngol. 1936;24:29–50.

    Article  Google Scholar 

  61. Yarington CT. The prognosis and treatment of cavernous sinus thrombosis. Review of 878 cases in the literature. Ann Otol Rhinol Laryngol. 1961;70:263–7.

    PubMed  Google Scholar 

  62. Levine SR, Twyman RE, Gilman S. The role of anticoagulation in cavernous sinus thrombosis. Neurology. 1988;38:517–22.

    Article  CAS  PubMed  Google Scholar 

  63. Shaw RE. Cavernous sinus thrombophlebitis: a review. Br J Surg. 1952;40:40–8.

    Article  CAS  PubMed  Google Scholar 

  64. Schuknecht B, Simmen D, Yüksel C, et al. Tributary venosinus occlusion and septic cavernous sinus thrombosis: CT and MR findings. AJNR Am J Neuroradiol. 1998;19:617–26.

    CAS  PubMed  Google Scholar 

  65. Choe CH, Trobe JD. Morning rounds: the potentially fatal red eye. EyeNet. 2009;13(3):69–71.

    Google Scholar 

  66. Southwick FS, Richardson Jr EP, Swartz MN. Septic thrombosis of the dural venous sinuses. Medicine (Baltimore). 1986;65:82–106.

    Article  CAS  Google Scholar 

  67. Hargrove RN, Wesley RE, Klippenstein KA, et al. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg. 2006;22:286–91.

    Article  PubMed  Google Scholar 

  68. Peterson KL, Wang M, Canalis RF. Rhinocerebral mucormycosis: evolution of the disease and treatment options. Laryngoscope. 1997;107:855–62.

    Article  CAS  PubMed  Google Scholar 

  69. Fleckner RA, Goldstein JH. Mucormycosis. Br J Ophthalmol. 1969;53:542–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  70. Schwartz JN, Donnelly EH, Klintworth GK. Ocular and orbital phycomycosis. Surv Ophthalmol. 1977;22:3–28.

    Article  CAS  PubMed  Google Scholar 

  71. Blitzer A, Lawson W, Meyers BR, et al. Patient survival factors in paranasal sinus mucormycosis. Laryngoscope. 1980;90:635–48.

    Article  CAS  PubMed  Google Scholar 

  72. Yohai RA, Bullock JD, Aziz AA, et al. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol. 1994;39:3–22.

    Article  CAS  PubMed  Google Scholar 

  73. Ferry AP. Cerebral mucornlycosis (phycomycosis). Ocular tindings and review of tile literature. Surv Ophthalmol. 1961;6:1–24.

    CAS  PubMed  Google Scholar 

  74. Ghadiali MT, Deckard NA, Farooq U, et al. Frozen-section biopsy analysis for acute invasive fungal rhinosinusitis. Otolaryngol Head Neck Surg. 2007;136:714–9.

    Article  PubMed  Google Scholar 

  75. Hofman V, Castillo L, Bétis F, et al. Usefulness of frozen section in rhinocerebral mucormycosis diagnosis and management. Pathology. 2003;35:212–6.

    Article  PubMed  Google Scholar 

  76. Langford JD, McCartney DL, Wang RC. Frozen section–guided surgical debridement for management of rhino-orbital mucormycosis. Am J Ophthalmol. 1997;124:265–7.

    CAS  PubMed  Google Scholar 

  77. Songu M, Unlu HH, Gunhan K, et al. Orbital exenteration: a dilemma in mucormycosis presented with orbital apex syndrome. Am J Rhinol. 2008;22:98–103.

    Article  PubMed  Google Scholar 

  78. Kahana A, Lucarelli MJ. Use of radiopaque intraorbital catheter in the treatment of sino-orbito-cranial mucormycosis. Arch Ophthalmol. 2007;125:1714–5.

    Article  PubMed  Google Scholar 

  79. Price JC, Stevens DL. Hyperbaric oxygen in the treatment of rhinocerebral mucormycosis. Laryngoscope. 1980;90:737–47.

    Article  CAS  PubMed  Google Scholar 

  80. Marsh RJ, Cooper M. Double-masked trial of topical acyclovir and steroids in the treatment of herpes zoster ocular inflammation. Br J Ophthalmol. 1991;75:542–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  81. Cobo LM, Foulks GN, Liesegang T, et al. Oral acyclovir in the therapy of acute herpes zoster ophthalmicus. An interim report. Ophthalmology. 1985;92:1574–83.

    Article  CAS  PubMed  Google Scholar 

  82. Whitley RJ, Weiss H, Gnann Jr JW, et al. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med. 1996;125:376–83.

    Article  CAS  PubMed  Google Scholar 

  83. Wood MJ, Johnson RW, McKendrick MW, et al. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med. 1994;330:896–900.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA

    Christina H. Choe M.D.

  2. Department of Ophthalmology & Visual Sciences and Neurology, University of Michigan, Ann Arbor, MI, USA

    Wayne T. Cornblath M.D.

Authors
  1. Christina H. Choe M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wayne T. Cornblath M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christina H. Choe M.D. .

Editor information

Editors and Affiliations

  1. Department of Ophthalmology, Associate Professor of Ophthalmology Wayne State University School of Med, Detroit, Michigan, USA

    Evan H. Black

  2. Oakland University William Beaumont, Clinical Professor of Ophthalmology Director, Oculoplastic Surgery, Southfield, Michigan, USA

    Frank A. Nesi

  3. Department of Ophthalmology, University of Central Florida, Orlando, USA

    Christopher J. Calvano

  4. William Beaumont School of Medicine, Clinical Professor of Ophthalmology Co-Director, Oculoplastic Surgery, Detroit, Michigan, USA

    Geoffrey J. Gladstone

  5. Former Chief of Ophthalmology, Emeritus Clinical Prof of Ophthalmology Case Western Reserve University, South Euclid, USA

    Mark R. Levine

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Choe, C.H., Cornblath, W.T. (2012). Orbital Signs of Parasellar Syndromes. In: Black, E., Nesi, F., Calvano, C., Gladstone, G., Levine, M. (eds) Smith and Nesi’s Ophthalmic Plastic and Reconstructive Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0971-7_53

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-0971-7_53

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-0970-0

  • Online ISBN: 978-1-4614-0971-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation