The ophthalmologist made a diagnosis of cavernous sinus
Diffusion MRI also showed a change of blood stream in the left cavernous sinus
, suggestive of thrombus.
Diffuse pachymeningeal enhancement involving the dura was noted, including asymmetric enhancement of the right cavernous sinus
. Differential diagnosis included sinonasal metastatic disease or fungal sinusitis.
It is bordered at the many serious structures like cavernous sinus
laterally, the eithmoidal air cells, anterior cranial fossa and optic nerve anteriorly, the clivus posteriorly, the hypophysis fossa and planum sphenoidale superiorly, choana inferiorly, internal carotid artery medially (Mamatha et al.; Seddinghi et al., 2014; Sevinc et al.; Farimaz et al., 2018).
However, surgery is not curative for certain macroadenoma and invasive tumours, especially the ones invading cavernous sinus
. In addition to traditional surgical and medical treatment options, SRS is now increasingly recognized as another treatment option6,7.
To the Editor: With the advent of antibiotics application, intracranial complications of paranasal sinusitis, including meningitis, intracranial abscess, subdural empyema (SDE), epidural abscess, cavernous sinus
thrombosis, and thrombosis of other dural sinuses, have become uncommon. However, SDE is still a life-threatening disease entity.
In a case series reported by Azin and Ashjazadeh (27) including 61 cases of CSVT, in 80.3% of the cases, the thrombosis was detected in the superior sagittal sinus; the sigmoid sinus was affected in 6.5% and cavernous sinus
thrombosis was detected in 4.9%.
There were also bony and dural changes along the anterior skull base with erosion of the sella turcica and lateral sphenoid bone toward the cavernous sinus
Imaging studies are indicated when neurologic signs are present, to rule out associated epidural or subdural empyema, brain abscess, or cavernous sinus
thrombosis15-17, but we have subjected all our patients to CT scan for assessment, complications and surgery.
It gives passage to an emissary vein that connects cavernous sinus
with pterygoid venous plexus and a nerve known as 'Nervoulus sphenoidalis lateralis.' Accessory meningeal artery may pass through the foramen in 20% cases.
Extension intra-cranially with compression of the dura and cavernous sinus
without invasion was noted.