Orbital apex syndrome

Current Opinion in Ophthalmology

Volumn 15, Issue 6, 2004, Pages 490-498

  Yeh, Steven ^a   Foroozan, Rod ^a  

^a CULLEN EYE INSTITUTE   (United States)

Author keywords

Cavernous sinus; Magnetic resonance imaging; Orbital apex; Superior orbital fissure; Tolosa Hunt syndrome

Indexed keywords

CORTICOSTEROID;

ANAMNESIS; BIOPSY; CAVERNOUS SINUS; CLINICAL FEATURE; COMPUTER ASSISTED TOMOGRAPHY; DIAGNOSTIC ACCURACY; DIAGNOSTIC IMAGING; DIAGNOSTIC VALUE; DIFFERENTIAL DIAGNOSIS; EVALUATION; HUMAN; IATROGENIC DISEASE; INFECTION; INFLAMMATION; INJURY; NEOPLASM; NUCLEAR MAGNETIC RESONANCE IMAGING; OPHTHALMOPLEGIA; OPTIC NERVE DISEASE; ORBIT APEX SYNDROME; ORBIT DISEASE; PRIORITY JOURNAL; REVIEW; SYMPTOM; TOLOSA HUNT SYNDROME; VISUAL IMPAIRMENT;

CRANIAL NERVES; HUMANS; OPHTHALMOPLEGIA; OPTIC NERVE DISEASES; ORBITAL DISEASES; PERIPHERAL NERVOUS SYSTEM DISEASES; SYNDROME; VISION DISORDERS;

EID: 9444231135     PISSN: 10408738     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.icu.0000144387.12739.9c     Document Type: Review

References (65)

1. Foroozan R: Transsphenoidal diplopia. Surv Ophthalmol 2004, 49:349-358.
2. Kline LB: The Tolosa-Hunt syndrome. Surv Ophthalmol 1982, 27:79-95.
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, 49:98-102. This retrospective analysis investigated the relationship between the number of cranial nerves affected and percentage of lesions located within the cavernous sinus. The authors collected 68 total patients with cranial nerve palsies and determined the percentage of patients with cavernous sinus lesions. In increasing order of cranial nerve involvement (one to four cranial nerves), 17.7%, 44.4%, 56.3%, and 77.8% of patients were found to have cavernous sinus lesions.
4. Keane JR: Cavernous sinus syndrome. Analysis of 151 cases. Arch Neurol 1996, 53:967-971.
5. Lenzi GL, Fieschi C: Superior orbital fissure syndrome. Review of 130 cases. Eur Neurol 1977, 16:23-30.
6. Thajeb P, Tsai J-J: Cerebral and oculorhinal manifestations of a limited form of Wegener's granulomatosis with c-ANCA-associated vasculitis. J Neuroimaging 2001, 11:59-63.
7. Zarei M, Anderson JR, Higgins JN, et al.: Cavernous sinus syndrome as the only manifestation of sarcoidosis. J Postgrad Med 2002, 48:119-121.
8. Calistri V, Mostardini C, Pantano P, et al.: Tolosa-Hunt syndrome in a patient with systemic lupus erythematosus. Eur Radiol 2002, 12:341-344.
9. Tokumaru AM, Obata T, Kohyama S, et al.: Intracranial meningeal involvement in Churg-Strauss syndrome. AJNR Am J Neuroradiol 2002, 23:221-224.
10. Islam N, Asaria R, Plant GT, et al.: Giant cell arteritis mimicking idiopathic orbital inflammatory disease. Eur J Ophthalmol 2003, 13:392-394. This is a case report of a 72-year-old woman who presented with a dull right eye ache, proptosis, and right-sided ophthalmoplegia. An elevated erythrocyte sedimentation rate and fluorescein angiogram showing almost complete choroidal non-perfusion suggested giant cell arteritis. Temporal artery biopsy confirmed the diagnosis.
11. Hunt WE: Tolosa-Hunt syndrome: one cause of painful ophthalmoplegia. J Neurosurg 1976, 44:544-549.
12. Hunt WE, Meagher JN, LeFever HE, et al.: Painful ophthalmoplegia. Its relation to indolent inflammation of the cavernous sinus. Neurology 1961, 11:56-62.
13. International Headache Society: The international classification of headache disorders. Cephalalgia 2004, 24(suppl 1):1-151. A description of THS and diagnostic criteria are given. THS is defined as episodic orbital pain associated with paralysis of one or more of the third, fourth, and/or sixth cranial nerves, which usually resolves spontaneously but tends to relapse and remit. Diagnostic criteria include one or more episodes of unilateral orbital pain persisting for weeks if untreated; paresis of one or more of the third, fourth, and/or sixth cranial nerves; and/or granuloma demonstrated by MRI or biopsy; paresis coinciding with pain or following it within 2 weeks; resolution of pain and paresis within 72 hours when treated with corticosteroids; and exclusion of other causes of painful ophthalmoplegia.
14. Kline LB, Hoyt WF: The Tolosa-Hunt syndrome. J Neurol Neurosurg Psychiatry 2001, 71:577-582.
15. Forderreuther S, Straube A: The criteria of the International Headache Society for Tolosa-Hunt syndrome need to be revised. J Neurol 1999, 246:371-377.
16. Yousem DM, Atlas SW, Grossman RI, et al.: MR imaging of Tolosa-Hunt syndrome. AJNR Am J Neuroradiol 1989, 10:1181-1184.
17. Bray WH, Giangiacomo J, Ide CH: Orbital apex syndrome. Surv Ophthalmol 1987, 32:136-140.
18. Balch K, Phillips PH, Newman NJ: Painless orbital apex syndrome from Mucormycosis. J Neuroophthalmol 1997, 17:178-182.
19. Fernandes YB, Ramina R, Borges G, et al.: Orbital apex syndrome due to Aspergillosis: case report. Arq Neuropsiquiatr 2001, 59:806-808.
20. Petrick M, Honegger J, Daschner F, et al.: Fungal granuloma of the sphenoid sinus and clivus in a patient presenting with cranial nerve III paresis: case report and review of the literature. Neurosurgery 2003, 52:955-959.
21. Bafna S, Lee AG: Presumed tuberculosis presenting as a cavernous sinus syndrome. J Neuroophthalmol 1997, 17:207-208.
22. Hui AC, Wong WS, Wong KS: Cavernous sinus syndrome secondary to tuberculous meningitis. Eur Neurol 2002, 47:125-126.
23. Rebai R, Boudawara MZ, Bahloul K, et al.: Cavernous sinus tuberculoma: diagnostic difficulties in a personal case. Surg Neurol 2001, 55:372-375.
24. Cannon ML, Antonio BL, McCloskey JJ, et al.: Cavernous sinus thrombosis complicating sinusitis. Pediatr Crit Care Med 2004, 5:86-88. This is a case report and literature review of cavernous sinus thrombosis in the setting of acute sinusitis. A 12-year-old girl presented in critically ill condition after 1 week of productive cough, progressive dyspnea, and left eye swelling. Spiral CT of the chest revealed septic emboli and lung abscesses. Head CT with contrast showed thromboses of the cavernous sinuses, superior ophthalmic veins, and facial veins. The patient recovered after parenteral antibiotics, but a right-sided optic neuropathy persisted.
25. Ebright JR, Pace MT, Niazi AF: Septic thrombosis of the cavernous sinuses. Arch Intern Med 2001, 161:2671-2676.
26. Southwick FS, Richardson EP Jr, Swartz MD: Septic thrombosis of the dural venous sinuses. Medicine 1986, 65:82-106.
27. Holland NR: CNS Actinomyces presenting with bilateral cavernous sinus syndrome. J Neurol Neurosurg Psychiatry 1998, 64:4.
28. Ohta S, Nishizawa S, Namba H, et al.: Bilateral cavernous sinus actinomycosis resulting in painful ophthalmoplegia. J Neurosurg 2002, 96:600-602.
29. Colson AE, Daily JP: Orbital apex syndrome and cavernous sinus thrombosis due to infection with Staphylococcus aureus and Pseudomonas aeruginosa. Clin Infect Dis 1999, 29:701-702.
30. Currie JN, Coppeto JR, Lessell S: Chronic syphilitic meningitis resulting in superior orbital fissure syndrome and posterior fossa gumma. A report of two cases followed for 20 years. J Clin Neuroophthalmol 1988, 8:145-159.
31. Fairley C, Sullivan TJ, Bartley P, et al.: Survival after rhino-orbital-cerebral mucormycosis in an immunocompetent patient. Ophthalmology 2000, 107:555-558.
32. Lee AG, Quick SJ, Liu GT, et al.: A childhood cavernous conundrum. Surv Ophthalmol 2004, 49:231-236. This is a case report and literature review of Burkitt lymphoma presenting with bilateral cavernous sinus lesions. A 9-year-old boy presented with left-sided toothache, headache, and, subsequently, vertical diplopia. Examination revealed a third nerve palsy, and cranial MRI showed bilateral cavernous sinus lesions. Blood smear and bone marrow biopsy revealed Burkitt lymphoma, which was treated with chemotherapy,
33. Kalina P, Black K, Woldenberg R: Burkitt's lymphoma of the skull base presenting as cavernous sinus syndrome in early childhood. Pediatr Radiol 1996, 26:416-417.
34. Rubin MM, Sanfilippo RJ: Lymphoma of the paranasal sinuses presenting as cavernous sinus syndrome. J Oral Maxillofac Surg 1992, 50:749-751.
35. Julien J, Ferrer X, Drouillard J, et al.: Cavernous sinus syndrome due to lymphoma. J Neurol Neurosurg Psychiatry 1984, 47:558-560.
36. Schick U, Bleyen J, Hassler W: Treatment of orbital schwannomas and neurofibromas. Br J Neurosurg 2003, 17:541-545. The authors discuss their treatment of five orbital peripheral nerve tumors. Two cases, both schwannomas, involved the orbital apex and superior orbital fissure. Their surgical management is outlined.
37. Vassilikos C, Pepe P, Christopoulos C: Ciliary neurinoma: a very rare intraorbital extraocular tumor causing orbital apex syndrome. Plast Reconstr Surg 2003, 112:1504-1505. This is a case report of a 75-year-old woman who presented with a 1-month history of decreased vision, diplopia, retroorbital pain, and exophthalmos. CT and MRI revealed a 12 × 16-mm mass involving the orbital apex. The mass was surgically removed and pathology revealed a benign ciliary neurinoma. The patient's pain resolved and visual acuity was partially restored.
38. Srinivasan S, Fern AI, Wilson K: Orbital apex syndrome as a presenting sign of maxillary sinus carcinoma. Eye 2001, 15:343-345.
39. McDonald HR, Char DH: Adenoid cystic carcinoma presenting as an orbital apex syndrome. Ann Ophthalmol 1985, 17:757-759.
40. Gore HL, Corin SM, Klussmann KG, et al.: Mucoepidermoid carcinoma presenting as an orbital apex syndrome. Ophthalmic Surg 1992, 23:59-61.
41. Veness MJ, Biankin S: Perineural spread leading to orbital invasion from skin cancer. Australas Radiol 2000, 44:296-302.
42. Ryan MW, Rassekh CH, Chaljub G: Metastatic breast carcinoma presenting as cavernous sinus syndrome. Ann Otol Rhinol Laryngol 1996, 105:666-668.
43. Auerbach DB, Bilyk JR: Lung cancer, proptosis, and decreased vision. Surv Ophthalmol 1999, 43:405-412.
44. Mehelas TJ, Kosmorsky GS: Painful ophthalmoplegia syndrome secondary to metastatic renal cell carcinoma. J Neuroophthalmol 1996, 16:289-290.
45. Harkness KA, Manford MR: Metastatic malignant melanoma presenting as a cavernous sinus syndrome. J Neurol 2004, 251:224-225. This is a case report of a 21-year-old fair-skinned man with a 10-day history of progressive bifrontal headache and diplopia. Partial third, fourth, and sixth nerve palsies were observed initially, and the patient's pupillary reaction was normal. CT of the brain and orbits was normal. Symptoms progressed to complete ptosis and ophthalmoplegia with a fixed, dilated pupil. Routine blood tests and MRI of the brain and orbits with gadolinium contrast were normal at this time. Excisional biopsy of two skin nevi showed dysplastic nevi but no malignant features. Diagnosis of malignant melanoma was made with a core biopsy of a 4.1-cm axillary lymph node. Despite whole-brain radiotherapy, the patient died 4 months after initial presentation after developing multiple metastases.
46. Piess M, Rizzo JF 3rd, Shang J: Orbital apex syndrome: a rare presentation of extramedullary hematopoiesis: case report and review of literature. J Neurooncol 2002, 57:37-40.
47. Yeh S, Yen MT, Foroozan R: Orbital apex syndrome after ethmoidal artery ligation for recurrent epistaxis. Ophthal Plast Reconstr Surg 2004, 20: 392-394. This is a case report of a 34-year-old man with severe, recurrent epistaxis who underwent external anterior and posterior ethmoidal artery ligation on the right side. Severe visual loss from optic neuropathy and complete ophthalmoplegia developed after surgery. CT revealed surgical clips within the right orbital apex. Emergent removal of the surgical clips and medial wall decompression were performed. Despite prompt recognition and treatment, severe visual loss and ophthalmoplegia persisted.
48. Vassallo P, Tranfa F, Forte R, et al.: Ophthalmic complications after surgery for nasal and sinus polyposis. Eur J Ophthalmol 2001, 11:218-222.
49. Jaison SG, Bhatty SM, Chopra SK, et al.: Orbital apex syndrome: a rare complication of septorhinoplasty. Indian J Ophthalmol 1994, 42:213-214.
50. Rene C, Rose GE, Lenthall R, et al.: Major orbital complications of endoscopic sinus surgery. Br J Ophthalmol 2001, 85:598-603.
51. Anderson RL, Panje WR, Gross CE: Optic nerve blindness following blunt forehead trauma. Ophthalmology 1982, 89:445-455.
52. Jarrahy R, Cha ST, Shahinian HK: Retained foreign body in the orbit and cavernous sinus with delayed presentation of superior orbital fissure syndrome: case report. J Craniofac Surg 2001, 12:82-86.
53. Atri A, Sheen V: Cavernous sinus syndrome and headache due to bilateral carotid artery aneurysms. Arch Neurol 2003, 60:1327-1328. This is a case report of an 89-year-old woman with a history of hypertension and Paget disease who developed right-sided headache. Two years earlier she had fallen, resulting in a fracture of her arm; weeks later, she developed pain and swelling in the right eye followed by numbness of the right forehead and blurred vision. Neurologic examination revealed right-sided ptosis, esotropia, complete ophthalmoplegia, and decreased sensation in the V1 and V2 dermatomes. MRI and MR angiography showed bilateral cavernous carotid aneurysms with thrombi. Attempted endovascular occlusion of the aneurysm on the right side was unsuccessful.
54. Lach B, Nair SG, Russell NA, et al.: Spontaneous carotid-cavernous fistula and multiple arterial dissections in type IV Ehlers-Danlos syndrome. J Neurosurg 1987, 66:462-467.
55. de Keizer R: Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity. Orbit 2003, 22:121-142. This is a retrospective review of 101 cases of direct dural carotid-cavernous and orbital arteriovenous fistulas. The diagnostic triad of arterialized loops, exophthalmos, and glaucoma are discussed. Diagnostic procedures such as ultrasound, color Doppler of the orbit and carotid systems, and MRI and MR angiography are reviewed. Management strategies including conservative therapy, balloon embolization, and direct or indirect surgery are discussed. Of the 10 orbital arteriovenous shunts with signs of dural fistulas, findings spontaneously resolved in eight patients, one patient required direct surgery (which was successful), and one patient's nonprogressive orbital findings persisted.
56. Tveteras K, Kristensen S, Dommerby H: Septic cavernous and lateral sinus thrombosis: modern diagnostic and therapeutic principles. J Laryngol Otol 1988, 102:877-882.
57. DiNubile MJ: Septic thrombosis of the cavernous sinuses. Arch Neurol 1988, 45:567-572.
58. Oliven A, Harel D, Rosenfeld T, et al.: Hypopituitarism after aseptic cavernous sinus thrombosis. Neurology 1980, 30:897-899.
59. Schuknecht B, Simmen D, Yuksel C, et al.: Tributary venosinus occlusion and septic cavernous sinus thrombosis: CT and MR findings. AJNR Am J Neuroradiol 1998, 19:617-626.
60. 2), and sixth cranial nerves was also improved with 3-T MRI. Three-tesla MRI was found to be superior to standard MRI for delineation of parasellar anatomy and tumor infiltration of the cavernous sinus, and may be valuable for intraoperative navigation.
61. Unger JM: Orbital apex fractures: the contribution of computed tomography. Radiology 1984, 150:713-717.
62. Schick U, Hassler W: Neurosurgical management of orbital inflammations and infections. Acta Neurochir (Wien) 2004, 146:571-580. This is a retrospective review of the treatment and clinical outcomes of 22 orbital inflammations and infections, with a subgroup involving the orbital apex. The surgical approach in each of these cases was determined by the anatomic location of the disease process within the orbit. A transantral approach was used in one patient with a mucocele involving the orbital apex and maxillary sinus. A pterional extradural approach was useful in two patients with lesions of the orbital apex. A pterional intradural operation was performed in five patients with inflammation of the optic canal extending into the intracranial space.
63. Smith JR, Rosenbaum JT: A role for methotrexate in the management of non-infectious orbital inflammatory disease. Br J Ophthalmol 2001, 85:1220-1224.
64. Hannerz J: Recurrent Tolosa-Hunt syndrome. Cephalalgia 1992, 12:45-51.
65. Mormont E, Laloux P, Vauthier J, et al.: Radiotherapy in a case of Tolosa-Hunt syndrome. Cephalalgia 2000, 20:931-933.