Diagnostica neuroradiologica nella patologia della loggia cavernosa

Translated title of the contribution: Neuroradiological study of cavernous sinus diseases

M. Mascalchi, C. Moroni, M. Bartolucci, C. Gavazzi, C. Bortolotti

Research output: Contribution to journalArticlepeer-review


The cavernous sinus may be the site of primary or secondary tumours, inflammatory or vascular diseases. With the exception of direct carotid-cavernous fistulae, all these diseases present similar clinical manifestations, so that diagnosis basically rests on imaging findings. Currently, the most useful methods for cavernous sinus investigation are computed tomography and magnetic resonance. Together with angio-CT and angio-MR, these techniques also allow angiographic-like study of the region of interest. Selective arteriography is still the gold standard techniques in the study of vascular disease (internal carotid aneurysms and carotid-cavernous fistulae). Nowadays, supra-orbital phlebography is confined to the diagnosis of Tolosa Hunt syndrome when MR is negative and sometimes in the endovascular treatment of arteriovenous fistulae. The most common primary tumours are meningiomas, whereas neurinomas of the cavernous sinus are extremely rare. Meningiomas arise from the dural coating of the sinus and present at CT and MR as well-defined lesions with early strong homogenous contrast enhancement. Neurinomas of the cavernous sinus may originate from the III, IV V or VI cranial nerves as primary tumours of the cavernous sinus or, more often, in the cisternal spaces involving the sinus developing along the nerve. Differential diagnosis is mainly between laterosellar development of a pituitary macroadenoma (the most common secondary tumour). The major criterion is involvement of the internal carotid which is frequently stenosed by meningiomas, whereas it may be surrounded and displaced by macroadenomas, without significant narrowing of its lumen. The cavernous sinus may be affected by two tumours of the skull base: rhinopharyngeal carcinoma and chordoma. Metastases of the cavernous sinus may be seeded through the blood, CSF or nerve tissue. They usually lead to sinus enlargement, lack a characteristic MR signal and must be distinguished from inflammatory diseases. Including Tolosa Hunt syndrome and chronic granulomatous disorders (sarcoidosis, Wegener's granulomatosis). Tolosa Hunt syndrome is characterised by retro-orbital pain, oculomotor paralysis and trigeminal hyperesthesia caused by inflammation of the sinus of unknown origin. MR scans may be negative and in some cases phlebography is useful for diagnostic purposes. A diagnostic criterion for inflammatory disease is the dramatic remission of symptoms and imaging findings following steroid therapy. Internal carotid aneurysms are classified by size: if the diameter is greater than 2.5 cm they are termed giant. The aneurysms have a thrombosed wall, a slight tendency to rupture and present with the clinical symptoms of compression of the nerves running in the wall or within the cavernous sinus. CT and MR techniques play a complementary role in the diagnosis of these lesions. The basic criterion is the vascular nature of the lesions, demonstrated by angio-CT, angio-MR and selective arteriography. Direct carotid-cavernous fistulae are high flow communication abnormalities between the internal carotid artery and the cavernous sinus. They are characterised by clinically sudden severe symptoms readily assessed with CT, angio-CT, MR, angio-MR and digital arteriography. Indirect carotid-cavernous fistulae are dural arteriovenous fistulae and usually give rise to more subtle clinical symptoms with an insidious course. Diagnosis in this case with CT, angio-CT, MR and angio-MR is more arduous since findings are confined to dilatation of the draining orbital vein. Arteriography will confirm the diagnosis and is also essential to plan endovascular or surgical treatment.

Translated title of the contributionNeuroradiological study of cavernous sinus diseases
Original languageItalian
Pages (from-to)375-386
Number of pages12
JournalRivista di Neuroradiologia
Issue number3
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology


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