Cavernous Sinus Syndrome

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.