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RESUMEN Los hemangiomas del seno cavernoso son considerados como malformaciones vasculares o tumores vasculares, se desarrollan extraaxiales, pero son histológicamente distintos a la malformación cavernomatosa cerebral. Su clínica puede ser cefalea, alteraciones visuales o paresia de pares craneales. Los métodos diagnósticos son la tomografía, pero principalmente la resonancia contrastada. El tratamiento puede ser mediante microcirugía o radioterapia. Se presenta el caso de un varón de 30 años, sin antecedentes, con 3 años de evolución de cefalea, y 7 meses de diplopía por paresia del VI par craneal. La resonancia contrastada evidencia un proceso expansivo en el seno cavernoso derecho, bordes regulares, hipointensa en T1, hipercaptador de contraste, hiperintensa en T2 y FLAIR, que no restringe en difusión. Se le realizó una craneotomía más resección total de la tumoración con apoyo de matriz hemostática para el control del sangrado. En el posoperatorio presento oftalmoparesia completa que fue mejorando en el tiempo. Se concluye que el hemangioma del seno cavernoso es una patología rara, con alta morbimortalidad asociada, pero con una adecuada técnica quirúrgica se pueden obtener buenos resultados.

ABSTRACT Cavernous sinus hemangioma is considered as a vascular malformation or as a vascular tumor. It is usually extra-axially located, but it is histologically different from cavernomatous cerebral malformations. Clinical features may include headache, visual alterations or cranial nerve palsy. Diagnostic methods include CT scans, but the best is contrast-enhanced magnetic resonance imaging (MRI). Therapy may be microsurgery or radiotherapy. We present the case of a 30-year-old male, with no relevant past history, who had suffered with headache for three years, and diplopia for the last seven months, due to paresis affecting the sixth cranial nerve. Contrast-enhanced MRI showed an expansive lesion in the right cavernous sinus, with regular borders, T1 hypointense, with significant contrast uptake, T2 and FLAIR hyperintense, with no diffusion restriction. A craniotomy plus total resection of the tumor with hemostatic matrix support for controlling bleeding was performed. This patient developed complete ophthalmoparesis that improved over time. It was concluded that cavernous sinus hemangioma is an unusual condition, with high associated morbidity and mortality rates, but good results may be achieved with an adequate surgical technique.

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RESUMO A trombose do seio cavernoso trata-se de uma afecção rara, caprichosa, associada à extensão de processos infecciosos, que podem ser de origem do terço médio facial, como sinusites que afetam os seios paranasais da face. A saber, os sítios primários de infecção são comumente a face, as órbitas e os seios etmoidal e esfenoidal. A apresentação clínica típica inclui febre e edema periorbital, seguido de cefaleia, ptose e paralisia da musculatura extraocular. O diagnóstico é eminentemente clínico e difícil de ser realizado. Salienta-se que o tratamento deve ser enfático para ser eficaz. O prognóstico dessa enfermidade é diretamente influenciado pela instalação de um tratamento precoce e adequado. Neste trabalho, objetiva-se relatar um caso de TSC em um paciente jovem, com apresentação clínica inicial típica de celulite pós-septal, evoluindo com oclusão de artéria da retina, evidenciando os principais aspectos clínicos, diagnósticos e terapêuticos, bem como a sua evolução.

ABSTRACT Cavernous sinus thrombosis is a rare, capricious condition, associated with the extension of infectious processes, which may originate from the middle third of the face, such as sinusitis that affects the paranasal sinuses of the face. Namely, the primary sites of infection are commonly the face, orbits and ethmoid, and sphenoid sinuses. The typical clinical presentation includes fever and periorbital edema followed by headache, ptosis and extraocular muscle paralysis. The diagnosis is eminently clinical and difficult to make. It should be noted that treatment must be emphatic to be effective. The prognosis of this disease is directly influenced by early and appropriate treatment. In this work, the objective is to report a case of cavernous sinus thrombosis in a young patient, with an initial clinical presentation typical of post-septal cellulitis, evolving with occlusion of the retinal artery, highlighting the main clinical, diagnostic, and therapeutic aspects as well as its evolution.

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Introducción: El síndrome de Tolosa-Hunt es la entidad nosológica de causa desconocida y diagnóstico por exclusión caracterizada por oftalmoplejía dolorosa y/o trastornos sensitivos del territorio correspondiente a la rama oftálmica del nervio trigémino del mismo lado. Presentación del caso: Paciente de sexo femenino de 72 años de edad con antecedentes de hipertensión arterial y diabetes mellitus tipo 2 que refirió 7 días previos, cefalea hemicraneal izquierda, pulsátil, continua, irradiada a órbita izquierda, sin alivio con analgésicos, asociada a ptosis palpebral izquierda y diplopía al lateralizar la mirada hacia la derecha. Se demostró por estudios de imagen, ocupación inflamatoria en fisura orbitaria superior izquierda y se diagnosticó síndrome de Tolosa-Hunt. Recibió tratamiento esteroideo con evolución satisfactoria y remisión total. Conclusiones: El síndrome de Tolosa-Hunt presenta como cuadro clínico fundamental la cefalea hemicraneal o periorbitaria asociada a oftalmoplejía, con demostración de inflamación granulomatosa en seno cavernoso, fisura orbitaria superior, ápex orbitario u órbita. Los corticoides sistémicos resultan de elección para su diagnóstico y evolución satisfactoria(AU)

Introduction: Tolosa-Hunt syndrome is the nosological entity of unknown cause and diagnosis by exclusion characterized by painful ophthalmoplegia and/or sensory disorders of the territory corresponding to the ophthalmic branch of the trigeminal nerve on the same side. Case report: The case of a 72-year-old female patient with history of high blood pressure and type 2 diabetes mellitus was reported, who 7 days before, had continuous, pulsating left hemicranial headache, radiating to the left orbit, with no relief with analgesics, associated with left eyelid ptosis and diplopia when lateralizing gaze to the right. Imaging studies showed inflammatory occupation in the left superior orbital fissure and Tolosa-Hunt syndrome was diagnosed. She received steroid treatment with satisfactory evolution and total remission. Conclusions: Tolosa-Hunt syndrome presents as its fundamental clinical condition hemicranial or periorbital headache associated with ophthalmoplegia, with demonstration of granulomatous inflammation in the cavernous sinus, superior orbital fissure, orbital apex or orbit. Systemic corticosteroids are of choice for diagnosis and satisfactory evolution(AU)

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Introducción: La cirugía del seno cavernoso se consideró durante mucho tiempo inviable (no accesible para el hombre) (5,31) debido al riesgo de sangrado o lesión de estructuras neurovasculares críticas, como la ACI, el nervio oculomotor, troclear y abducens (5.31). Desde entonces, numerosos estudios han contribuido a comprender la anatomía microquirúrgica del seno cavernoso. En 1965, Parkinson (25) realizó el primer abordaje del seno cavernoso para el tratamiento de la fístula carótida-cavernosa. Fue el comienzo de la era moderna en la cirugía del seno cavernoso y abrió la puerta a muchas publicaciones que detallan los abordajes quirúrgicos de diversas lesiones dentro y alrededor del seno cavernoso. Junto al desarrollo y la mejora de la neuroimagen y la anatomía microquirúrgica, permitieron acceder con éxito al seno cavernoso. Nuestro objetivo es presentar una revisión narrativa de vanguardia de la anatomía microquirúrgica del seno cavernoso y el manejo interdisciplinario. Para lograr este propósito, se realizó la disección cadavérica de 2 cabezas (cuatro senos cavernosos) reflejada en 2 casos quirúrgicos, además de una revisión bibliográfica exhaustiva que orienta el manejo multimodal de los tumores que se encuentran dentro o alrededor del seno cavernoso. Objetivo: Describir la anatomía quirúrgica del seno cavernoso a través de disecciones cadavéricas y su aplicación microquirúrgica. Materiales y métodos: Se estudiaron 4 senos cavernosos cadavéricos humanos fijados en formol. Las arterias y venas fueron inyectadas con silicona coloreada, las imágenes fueron tomadas con una cámara DSLR Nikon 3400 profesional de 24,2 megapíxeles. Resultados: El seno cavernoso es un compartimento dural que contiene estructuras neurovasculares críticas, cuya disección debe ser realizada de forma cuidadosa y prolija por el inminente riesgo de lesión de las mismas. Es así que lesiones confinadas por ejemplo a la pared lateral (caso clínico 2) tienen mayor probabilidad de remoción total, por lo tanto mejor pronóstico, no así las lesiones que invaden el seno cavernoso (caso clínico 1) donde la probabilidad de remoción total disminuye y el riesgo de lesión neurovascular aumenta. Conclusiones: El conocimiento preciso de la anatomía microquirúrgica del seno cavernoso y el manejo multimodal son cruciales en el manejo y pronóstico del paciente(AU)

Background: Cavernous sinus surgery was long considered unfeasible (not accessible to humans) (5.31) due to the risk of bleeding or injury to critical neurovascular structures, such as the ICA, oculomotor, trochlear and abducens nerves (5.31). Since then, numerous studies have contributed to understanding the microsurgical anatomy of the cavernous sinus. In 1965, Parkinson (25) performed the first approach to the cavernous sinus for the treatment of carotid-cavernous fistula. This was the beginning of the modern era in cavernous sinus surgery and opens the door to many publications detailing surgical approaches to various injuries in and around the cavernous sinus. Together with the development and improvement of neuroimaging and microsurgical anatomy, they allowed successful access to the cavernous sinus. Our goal is to present a state-of-the-art narrative review of cavernous sinus microsurgical anatomy and interdisciplinary management. To achieve this purpose, cadaveric dissection of 2 heads (four cavernous sinuses) was performed, reflected in 2 surgical cases, in addition to an exhaustive literature review that guides the multimodal management of tumors found within or around the cavernous sinus. Objective: The aim of this study is to describe the surgical anatomy of the cavernous sinus through cadaveric dissections and its microsurgical application. Methods: 4 human cadaveric cavernous sinuses fixed in formalin were studied, the arteries and veins were injected with colored silicone, the images were taken with a 24.2-megapixel Nikon 3400 professional DSLR camera. Results: The cavernous sinus is a dural compartment that contains critical neurovascular structures, whose dissection must be performed carefully and neatly due to the imminent risk of injury to them, so lesions confined, for example, to the lateral wall (clinical case 2 ) have a higher probability of total removal and therefore a better prognosis, but not lesions that invade the cavernous sinus (clinical case 1) itself, where the probability of total removal decreases and the risk of neurovascular injury increases. Conclusions: Precise knowledge of the microsurgical anatomy of the cavernous sinus and multimodal management are crucial in the management and prognosis of the patient

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ABSTRACT A 53-year-old man with a 3-day history of periorbital swelling and vision loss in the left eye was found to have septic cavernous sinus thrombosis with bilateral orbital vein involvement causing congestive orbitopathy. He was treated with an emergent canthotomy and cantholysis, intraocular pressure-lowering drops, antibiotics, anticoagulation, and serial examinations. Optical coherence tomography ultimately revealed diffuse ischemic destruction of both layers of the retina, which suggested occlusion of the ophthalmic artery or the short posterior ciliary arteries and central retinal artery without intracavernous internal carotid artery involvement. The patient remained without light perception in the left eye after treatment.

RESUMO Um homem de 53 anos, com história de 3 dias de edema periorbital e perda de visão no olho esquerdo, apresentou trombose séptica do seio cavernoso com envolvimento bilateral das veias orbitais, causando uma orbitopatia congestiva. O paciente foi tratado com uma cantotomia e cantólise de emergência, colírios para redução da pressão intraocular, antibióticos, anticoagulantes e exames seriados. A tomografia de coerência óptica finalmente demonstrou destruição isquêmica difusa de ambas as camadas da retina, sugerindo uma oclusão da artéria oftálmica ou das artérias ciliares posteriores curtas e da artéria retiniana central, com ausência de envolvimento do segmento intracavernoso da artéria carótida interna. O paciente permaneceu sem percepção luminosa no olho esquerdo.

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ABSTRACT Cavernous sinus and superior ophthalmic vein thrombosis is a rare clinical condition, and little described in the literature. The clinical presentation is nonspecific and highly variable, and symptoms may include red eye, ophthalmoplegia, coma, and death. The main etiology results from infection of the paranasal sinuses. The final diagnosis must be made through imaging tests such as magnetic resonance imaging. We describe a case of cavernous sinus and superior ophthalmic vein thrombosis after COVID-19 infection in a 64-year-old patient with persistent ocular hyperemia and pain on eye movement. Ophthalmological examination showed preserved visual acuity, conjunctival hyperemia, dilation of episcleral vessels and retinal vascular tortuosity in the right eye. Magnetic resonance imaging confirmed the diagnosis. The association with the COVID-19 was raised, excluding other infectious causes. Enoxaparin and Warfarin were started with significant improvement in the ocular clinical presentation and maintenance of initial visual acuity after 12 months of follow-up.

RESUMO A trombose de seio cavernoso e veia oftálmica superior é uma condição clínica rara e pouco descrita na literatura. A apresentação clínica é inespecífica e altamente variável. Os sintomas podem incluir olho vermelho, oftalmoplegia, coma e morte. A etiologia principal resulta da infecção dos seios paranasais. O diagnóstico final deve ser efetuado por meio de exames de imagem, como ressonância magnética. Descrevemos um caso de trombose de seio cavernoso e veia oftálmica superior após COVID-19 em paciente de 64 anos e com quadro de hiperemia ocular persistente e dor à movimentação ocular. Ao exame oftalmológico, observou-se acuidade visual preservada, hiperemia conjuntival, dilatação de vasos episclerais e tortuosidade vascular retiniana em olho direito. A ressonância confirmou o diagnóstico. A associação com a COVID-19 foi levantada, excluindo-se demais causas infecciosas. Prescrevemos enoxaparina e varfarina, com melhora do quadro clínico ocular e manutenção da acuidade visual inicial após 12 meses de acompanhamento.

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Introducción: La apoplejía hipofisaria es un síndrome que se produce como consecuencia de una lesión isquémica o hemorrágica en la glándula pituitaria dando lugar a un déficit de hormonas hipofisarias. Se manifiesta en forma de deterioro neurológico con cefalea en trueno como síntoma prínceps, siendo la irritación meníngea una manifestación infrecuente. Métodos: Presentamos el caso de una mujer de 53 años con antecedente de madroadenoma productor de prolactina que comienza con cefalea, náuseas y deterioro de nivel de consciencia. Se detecta un hipopituitarismo incompleto con nivel de cortisol normal. El líquido cefalorraquídeo (LCR) es consistente con una pleocitosis aséptica sin respuesta a terapias antibióticas. Asocia paresia oculomotora y una RM craneal revela sangrado en el adenoma hipofisario con compromiso de seno cavernoso. Resultados: la sospecha inicial es una meningoencefalitis bacteriana por la fiebre, estupor y LCR con pleocitosis, si bien no se identifica microorganismo y no hay respuesta a antibióticos. El LCR de la apoplejía muestra una pleocitosis aséptica por irritación meníngea del espacio subaracnoideo por el sangrado y la necrosis de la glándula. El hipopituitarismo puede ser parcial o completo, siendo más frecuente el déficit selectivo. Especial atención merece el déficit de ACTH por la morbimortalidad que conlleva el fallo adrenal. La oftalmoparesia traduce implicación de seno cavernoso por incremento en la presión selar. Conclusiones: Destacamos la importancia de tener una sospecha diagnóstica de apoplejía ante un cuadro neurológico agudo para dirigir las investigaciones pertinentes con determinación hormonal y así iniciar una terapia sustitutiva temprana y una actitud neuroquirúrgica en caso de ser necesaria; precisando un manejo multidisciplinar.

Introduction: Pituitary apoplexy is a syndrome that occurs as a result of an ischemic or hemorrhagic lesion in the pituitary gland, leading to a deficiency of pituitary hormones. It manifests in the form of neurological deterioration with thunderclap headache as the main symptom, with meningeal irritation being an infrequent manifestation. Methods: We present the case of a 53-year-old woman with a history of prolactin-producing madroadenoma that began with headache, nausea and impaired level of consciousness. Incomplete hypopituitarism with normal cortisol level is detected. Cerebrospinal fluid (CSF) is consistent with an aseptic pleocytosis unresponsive to antibiotic therapy. It is associated with oculomotor paresis and a cranial MRI reveals bleeding in the pituitary adenoma with involvement of the cavernous sinus. Results: the initial suspicion is bacterial meningoencephalitis due to fever, stupor and CSF with pleocytosis, although no microorganism is identified and there is no response to antibiotics. CSF from stroke shows aseptic pleocytosis due to meningeal irritation of the subarachnoid space from bleeding and necrosis of the gland. Hypopituitarism can be partial or complete, selective deficiency being more frequent. ACTH deficiency deserves special attention due to the morbidity and mortality that adrenal failure entails. Ophthalmoparesis translates involvement of the cavernous sinus due to an increase in sellar pressure. Conclusions: We emphasize the importance of having a suspected diagnosis of apoplexy in case of an acute neurological condition, to direct the pertinent investigations with hormonal determination and thus initiate early replacement therapy and a neurosurgical approach if necessary; requiring a multidisciplinary management.

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Introducción: Entre las cefaleas secundarias se encuentra la atribuida a flebotrombosis cerebral producida por trombosis séptica del seno cavernoso. El ganglio esfenopalatino interviene en la génesis y mantenimiento de cefaleas unilaterales; pues envía conexiones a la cavidad nasofaríngea y meninges, así desempeña una función importante en la modulación neuronal; el bloqueo de dicho ganglio es un método fácil, seguro, económico y efectivo de tratamiento del dolor irruptivo de algunos tipos de cefalea. Objetivo: Presentar los resultados del bloqueo GEFP en el tratamiento de la cefalea grave refractaria secundaria a trombosis séptica del seno cavernoso. Presentación de caso: Paciente de 71 años de edad, al que se realizó de forma exitosa bloqueo transnasal del ganglio esfenopalatino, para tratamiento de cefalea grave refractaria secundaria a trombosis séptica del seno cavernoso, consiguiéndose analgesia efectiva con disminución progresiva de la cefalea y control total de la misma a las 72 h de tratamiento. Conclusiones: El bloqueo podría constituir una opción en la terapéutica de este tipo de cefalea(AU)

Introduction: Among secondary headaches, one is attributed to cerebral phlebothrombosis produced by septic thrombosis of the cavernous sinus. The sphenopalatine ganglion (SPG) is involved in the genesis and maintenance of unilateral headaches, since it sends connections to the nasopharyngeal cavity and meninges, playing thus an important role in neuronal modulation; therefore; the blockade of this ganglion is an easy, safe, economic and effective method for treating breakthrough pain in some types of headache. Objective: To present the results of SPG blockade in the treatment of refractory severe headache produced by septic thrombosis of the cavernous sinus. Case presentation: A 71-year-old male patient is presented, who was successfully performed a transnasal SPG blockade, as a treatment for refractory severe headache caused by septic thrombosis of the cavernous sinus. Effective analgesia is achieved, together with progressive decrease of headache until it was totally controlled at 72 hours. Conclusions: Blockade was an option in the therapy of this type of headache(AU)

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RESUMEN INTRODUCCIÓN: El síndrome de Tolosa-Hunt (STH) se caracteriza por una oftalmoplejía dolorosa, de etiología desconocida. De acuerdo con los hallazgos histopatológicos, se ha descrito la formación de un tejido granulomatoso en los senos cavernosos. PRESENTACIÓN DEL CASO: Una mujer de 22 años con cuadro clínico de 3 semanas de evolución caracterizado por cefalea hemicránea derecha, dolor ocular derecho y diplopía. Su examen físico evidenció la existencia de una oftalmoplejía derecha; la resonancia magnética (RM) de silla turca demostró engrosamiento y realce en la región del seno cavernoso derecho. Se presenta el caso clínico de una causa inusual de oftalmoplejía dolorosa. DISCUSIÓN: La oftalmoplejía dolorosa tiene múltiples diagnósticos diferenciales que incluyen causas neoplá-sicas, vasculares, inflamatorias e infecciosas que pueden afectar el seno cavernoso o la fisura orbitaria superior. El STH, que es una causa rara de oftalmoplejía dolorosa, sigue siendo un diagnóstico de exclusión. Por otra parte, se caracteriza por tener una adecuada respuesta al tratamiento con glucocorticoides. CONCLUSIÓN: La negatividad en las investigaciones de las etiologías de oftalmoplejía, los hallazgos imagenológicos en la RM y la adecuada respuesta cínica con el uso de los corticoides permiten confirmar el diagnóstico. No debería ser necesaria la biopsia del seno cavernoso ante la sospecha de STH con adecuada respuesta al manejo corticoide.

ABSTRACT INTRODUCTION: Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia of unknown etiology, the formation of a granulomatous tissue in the cavernous sinuses has been described in histopatho-logical findings. CASE PRESENTATION: A 22-year-old woman presenting with 3 weeks of right sided headache, right eye pain and diplopia. Physical examination revealed the existence of a right ophthalmoplegia; magnetic resonance imaging (MRI) of the sella turcica showed thickening and enhancement of the right cavernous sinus. A clinical case of an unusual cause of painful ophthalmoplegia is presented. DISCUSSION: Painful ophthalmoplegia has multiple differential diagnoses that include neoplastic, vascular, inflammatory and infectious causes that can affect the cavernous sinus or the superior orbital fissure. STH is a rare case of painful ophthalmoplegia that continues to be a diagnosis of exclusion characterized by an adequate response to treatment with glucocorticoids. CONCLUSION: The negativity of the investigations for the causes of ophthalmoplegia, the imaging findings in the MRI and the adequate response to corticosteroids allows the diagnosis to be made. Biopsy should not be necessary when THS is suspected and there is an adequate response to corticosteroid management.

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Resumen La fístula carótido-cavernosa es cualquier comunicación anómala entre la arteria carótida y el seno cavernoso que genera un shunt arteriovenoso patológico, se manifiesta en forma anterógrada a la órbita, causa ceguera y oftalmoparesia. Su asociación con trauma craneoencefálico leve es escasa y poco reportada, por lo que se desconoce su prevalencia. Se reporta un paciente masculino de 54 años proveniente de Cali, Colombia, con antecedente de trauma craneoencefálico leve 2 meses antes del ingreso, quien presenta cuadro de cefalea holocraneal y alteraciones visuales. Al examen físico presentó oftalmoparesia, con ptosis palpebral bilateral asimétrica y proptosis pulsátil izquierda; se realizó resonancia magnética cerebral simple y angioresonancia, con hallazgos sugestivos de fístula carótido-cavernosa. El paciente fue llevado a arteriografía más embolización, logrando un resultado favorable. La presencia de cefalea con banderas rojas, alteraciones visuales, proptosis pulsátil y el antecedente de trauma craneoencefálico, sin importar su grado, pueden hacer sospechar la presencia de esta entidad.

Abstract The carotid-cavernous fistula is any abnormal communication between the carotid artery and the cavernous sinus, generating a pathological arteriovenous shunt manifesting anterograde to the orbit, causing blindness and ophthalmoparesis. Its association with mild head trauma is scarce and underreported, its prevalence being unknown. A 54-year-old male patient from Cali - Colombia is reported, with a history of mild cranioencephalic trauma 2 months ago, who consulted for a holocranial headache and visual disturbances. On physical examination he presented ophthalmoparesis, with bilateral asymmetric palpebral ptosis with left pulsatile proptosis. A simple brain magnetic resonance and angio-MRI was performed, with findings suggestive of a carotid-cavernous fistula. The patient was taken to arteriography plus embolization, achieving a favorable result. The presence of headache with red flags, visual disturbances, pulsatile proptosis, and a history of head trauma, regardless of its degree, can lead to suspect the presence of this entity.

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Cavernous Sinus Thrombosis (CST) is an uncommon neurological infection that affects the cavernous sinus of the dura mater, which can lead to death. When untreated, odontogenic infections can cause CST, since facial veins do not have valves. The diagnosis consists of the clinical characteristics added to imaging exams such as computed tomography (CT) and magnetic resonance imaging (MRI). The effectiveness of antibiotic therapy in significantly reducing mortality has been proven, but therapy with anticoagulants and corticosteroids remains unknown in the literature. Objective: The purpose of the study is to make a literature review on etiology, paraphysiology, symptoms, complementary exa-ms, diagnosis and outcome of patients who presented CST as a result of an odontogenic infection. Materials and methods: a literature review was carried out, using articles from the Pubmed, Lilacs and Cochrane databases, from the last 10 years in the English langua-ge and reference articles to complement. The Mesh terms used were 'Cavernous Sinus Thrombosis', 'Cavernous Sinus Thrombosis AND Odontogenic Infections' and 'Cavernous Sinus Thrombosis AND Dental Infection'. Conclusion: CST motivated by odontogenic infections is a rare but extremely dangerous disorder that must be discovered early in order for the patient's prognosis to be favorable. It is necessary to pay attention to the clinical signs and to the analysis of the imaging exams so that the differential diagnosis is made. (AU)

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Objective:To investigate the clinicopathological features, treatment programs and prognosis of patients with primary diffuse large B-cell lymphoma (DLBCL) in cavernous sinus.Methods:The clinical data of a patient with primary DLBCL in cavernous sinus who were admitted to Wuhan No.1 Hospital in December 2020 were retrospectively analyzed, and the relevant literature was reviewed.Results:The patient was a 63-year-old female who underwent resection of the cavernous sinus lesion, and the pathological diagnosis was DLBCL. The patient received 6 courses of R-CHOP regimen chemotherapy, lumbar puncture + intrathecal injection of chemotherapy drugs, and twice additional rituximab immunochemotherapy, and no tumor cells were found in the results of liquid-based thin layer cytology for cerebrospinal fluid exfoliated cells; twice magnetic resonance imaging (MRI) re-examination after the operation showed no recurrence and adjacent metastasis of the tumor. The patient's symptoms were significantly improved without residual neurological sequelae.Conclusions:Primary DLBCL in cavernous sinus is rare in clinical practice, early diagnosis is crucial for the prognosis of patients, and different protein expression may indicate the prognosis. Biopsy, complete resection of the tumor under the premise of preserving important anatomical structures and functions, and standardized chemotherapy combined with intrathecal injection local chemotherapy can effectively prolong the survival time of patients and improve the quality of life.

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SUMMARY: A comparative study of the morphology of suboccipital cavernous sinus (SCS) using MRI and cast specimens was performed. The present retrospective study analysed the craniocervical magnetic resonance venography (MRV) imaging data of 61 patients. Three-dimensional reconstruction was performed using Mimics 19.0. The SCS left-right diameter(d1), distance from the midline (d2), supero-inferior diameter(d3), anteroposterior diameter (d4), distance from posterior diameter to skin (d5), and diameter of the SCS at different parts (d6-d8) were measured. Comparison between MRV images and cast specimens, the SCS, marginal sinus, anterior condylar vein, and vertebral artery venous plexus were symmetrical and could be bilaterally displayed, whereas the presence of extra condylar vein and posterior condylar vein exhibited different types. The adjacency between the SCS and its communicating vessels and changes in its communicating vessels corresponded well with the MRV images and cast specimens. Many types of the presence of left and right lateral condylar and posterior condylar veins were found in the cast specimens, which could be divided into the bilateral presence of posterior condylar and lateral condylar veins, unilateral presence of posterior condylar veins, and unilateral presence of lateral condylar vein. A total of 61 cases analysed using MRV images revealed the bilateral presence of posterior condylar and lateral condylar veins (77.1 %), the unilateral presence of posterior condylar vein (18.0 %), and the unilateral presence of lateral condylar vein (9.8 %), of which the bilateral presence of posterior condylar and lateral condylar veins accounted for the largest proportion. MRV images and cast specimens of the SCS showed its normal morphological structure and adjacency, thus providing accurate and complete Three-dimensional imaging anatomical data of the SCS and its communicating vascular structures. This study enriches the Chinese SCS imaging anatomy data and may be valuable in clinical practice.

RESUMEN: Se realizó un estudio comparativo de la morfología del seno cavernoso suboccipital (SCS) mediante resonancia magnética y muestras de yeso. El presente estudio retrospectivo analizó los datos de imágenes de venografía por resonancia magnética (RNM) craneocervical de 61 pacientes. La reconstrucción tridimensional se realizó con Mimics 19.0. Se midió: el diámetro izquierdo-derecho del SCS (d1), la distancia desde la línea mediana (d2), el diámetro superoinferior (d3), el diámetro anteroposterior (d4), la distancia desde el diámetro posterior hasta la piel (d5) y el diámetro del SCS en diferentes partes (d6-d8). En la comparación entre las imágenes RNM y las muestras de yeso, el SCS, el seno marginal, la vena condilar anterior y el plexo venoso de la arteria vertebral eran simétricos y se observaron bilateralmente, mientras que la presencia de la vena extracondilar y la vena condilar posterior presentaba tipos diferentes. La proximidad del SCS y sus vasos comunicantes y los cambios en sus vasos comunicantes se correspondieron bien con las imágenes de RNM y los especímenes moldeados. Se encontraron muchos tipos de venas condilares laterales y condilares posteriores izquierda y derecha en las muestras de yeso, que podrían dividirse en presencia bilateral de venas condilares posteriores y condilares laterales, presencia unilateral de venas condilares posteriores y presencia unilateral de venas condilares laterales. Un total de 61 casos analizados mediante imágenes MRV revelaron la presencia bilateral de venas condilares posteriores y condilares laterales (77,1 %), la presencia unilateral de venas condilares posteriores (18,0 %) y la presencia unilateral de venas condilares laterales (9,8 %) de los cuales la presencia bilateral de las venas condilar posterior y condilar lateral representó la mayor proporción. Las imágenes de RNM y las muestras de yeso del SCS mostraron su estructura morfológica y adyacencia normales, lo que proporcionó datos anatómicos de imágenes tridimensionales precisos y completos del SCS y sus estructuras vasculares comunicantes. Este estudio enriquece los datos de anatomía de imágenes de SCS chino y puede ser valioso en la práctica clínica.

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ABSTRACT Septic cavernous sinus thrombosis is a rare but often debilitating and potentially fatal disease. We describe a case of bilateral orbital cellulitis with rapidly progressing cavernous sinus thrombosis and left sigmoidal sinus thrombosis in an immunocompetent 20-year-old military man who had undergone intensive physical training. The patient presented with rapid painful swollen left eye for 2 days. The examination results were gross proptosis with total ophthalmoplegia. He was treated with intravenous antibiotics and corticosteroid. At 1 week, visual acuity improved to 20/20 OU, with a normal intraocular pressure. There was a significant improvement in proptosis. The ocular motility of the right eye was fully restored, with slight residual ophthalmoplegia in the left eye. There was no residual illness or recurrence of illness at 3 months' follow-up.

RESUMO A trombose séptica do seio cavernoso é uma condição rara, mas frequentemente debilitante e potencialmente fatal. Descrevemos um caso de celulite orbital bilateral com progressão rápida para trombose do seio cavernoso e trombose do seio sigmoide esquerdo, em um militar imunocompetente de 20 anos de idade que havia sido submetido a treinamento físico intenso. O paciente apresentou um inchaço rápido e doloroso no olho esquerdo por 2 dias. Os resultados do exame foram proptose macroscópica com oftalmoplegia total. Ele foi tratado com antibióticos intravenosos e costicosteróide. Em 1 semana, a acuidade visual melhorou para 20/20, com pressão intraocular normal. Houve uma melhora significativa na proptose. A motilidade ocular do olho direito foi totalmente restaurada, com leve oftalmoplegia residual no olho esquerdo. Não houve doença residual ou recorrência da doença após três meses de acompanhamento.

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Background@#Cavernous Sinus Thrombosis (CST) is a rare and life-threatening condition with antibiotics as the mainstay of therapy for those due to infection. While controversy exists, recent retrospective reviews using anticoagulation reveal potential mortality reduction with a low risk of adverse events such as intracranial hemorrhage (ICH). The optimal timing and duration of treatment are unknown.@*The Case@#We report a 32-year-old female who presented with fever, headache, complete bilateral ophthalmoplegia, cellulitis, and a cranial MRV diagnostic of CST. She received antibiotics targeted to MRSA organisms isolated from eye and blood specimen. Further, into the course, the patient had an onset of aphasia and right-sided hemiplegia. Workup revealed multiple cranial infarcts with narrowing of the left internal carotid artery, likely representing thrombus as the source of embolism. The decision to anticoagulate was reevaluated and subsequently started. The patient was reassessed clinically after two months to have improved motor strength and speech return; thus, anticoagulation was discontinued.@*Discussion@#Although data are lacking, most recent reports favor the use of anticoagulation. Some authors recommend initiation in patients with deteriorating neurologic status despite antibiotics and hydration. The higher frequency of ICH in anticoagulated CST patients with CNS infection is a basis for some authors to withhold treatment. The treatment duration varies with different studies, generally ranging from several weeks to three months or more.@*Conclusion@#Further studies are needed to define the exact role of anticoagulation, particularly its timing and duration. Nevertheless, timely identification of the condition and constant re-evaluation are critical to early patient recovery.

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The anterior clinoid process (ACP) is an important anatomical structure of the skull base. Some surgeries for intracranial lesions require to remove the ACP in order to achieve visual field exposure of the lesions and surrounding anatomical structure, and provide sufficient operating space. In this paper, the research progress in anatomy and variation of the ACP, methods of anterior clinoidectomy, and applications of anterior clinoidectomy in neurosurgical surgerys are summarized as follows.

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La trombosis séptica del seno cavernoso se conoce como una complicación rara y potencialmente mortal de las infecciones en el área de la cabeza y el cuello. Aunque el uso de antibióticos ha mejorado el pronóstico, todavía es conocida por sus altas tasas de mortalidad y morbilidad. Objetivo: Analizar la presencia de la trombosis séptica de seno cavernoso mediante el estudio de un caso único. Metodología: De tipo observacional, cualitativa y de corte transversal, apoyado con sustento bibliográfico. Resultado: Caso de una paciente joven de sexo femenino que presenta una semana después de tener sintomatología de Covid, cefalea holocraneana, oftalmoplejía derecha, disminución de la agudeza visual, dolor, eritema, edema, tumefacción orbitaria, secreción ocular amarillenta supurativa derecha, se le realiza tomografía de cerebro evidenciándose de forma incidental trombosis del seno cavernoso. Conclusiones: Se determinó que la trombosis séptica de seno cavernoso es un diagnóstico de poca frecuencia y rara. Asimismo, la trombosis del seno cavernoso tiene la tasa más alta de mortalidad. En raras ocasiones, la infección del oído medio puede ser una causa de trombosis séptica del seno cavernoso y la respuesta al tratamiento es deficiente(AU)

Cavernous sinus septic thrombosis is a rare and life-threatening complication of infections in the head and neck area. Although the use of antibiotics has improved the prognosis, it still known for its high mortality and morbidity rates. Objective: To analyze the presence of cavernous sinus septic thrombosis by studying a single case. Methodology: Observational, qualitative and cross-sectional, supported by bibliographic support. Result: Case of a young female patient who presented one week after having symptoms of Covid, holocranial headache, right ophthalmoplegia, decreased visual acuity, pain, erythema, edema, orbital swelling, right suppurative yellowish eye discharge, was performed brain tomography, incidentally showing cavernous sinus thrombosis. Conclusions: It was determined that cavernous sinus septic thrombosis is an infrequent and rare diagnosis. In addition, cavernous sinus thrombosis has the highest mortality rate. In rare cases, middle ear infection can be a cause of cavernous sinus septic thrombosis and response to treatment is poor(AU)

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Objective To describe the endoscopic and microsurgical anatomy of the cavernous sinus (CS) with focus on the surgical landmarks in microsurgical anatomy. Materials and methods Ten formalin-fixed central skull base specimens (20 CSs) with silicone-injected carotid arteries were examined through an extended endoscopic transsphenoidal approach. Fifteen formalin-fixed heads were dissected to simulate the surgical position in CS approaches. Results Endoscopic access enables identification of the anterior and posterior surgical corridors. Structures within the CS and on its lateral wall could be visualized and studied, but none of the triangular areas relevant to the transcranial microsurgical anatomy were fully visible through the endoscopic approach. Conclusion The endoscopic approach to the CS is an important surgical technique for the treatment of pathological conditions that affect this region. Correlating endoscopic findings with the conventional (transcranial)microsurgical anatomy is a useful way of applying the established knowledge into a more recent operative technique. Endoscope can provide access to the CS and to the structures it harbors.

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Los meningiomas de nervio óptico y de seno cavernoso son patologías poco frecuentes, y hasta el momento no ha habido ningún reporte de que se presenten ambos en un mismo paciente. Cabe resaltar que cuando llega un paciente a consulta diagnosticado con alguna patología, asumimos que este diagnóstico es adecuado y pertinente. Pero en nuestro caso, el paciente presentó signos y síntomas de etiología desconocida que hicieron que se re-evaluarán los diagnósticos oftalmológicos que traía la paciente, encontrando que había sido tratada por un diagnóstico que no le correspondía y a su vez este hallazgo nos ayudó a encontrar la verdadera causa(AU)

Optic nerve and cavernous sinus meningiomas are uncommon pathologies, and so far there have not been previously reported to occur in the same patient. It should be emphasized that when a patient arrives at a doctor's office diagnosed with pathology, we assume that this diagnosis is appropriate and pertinent. But in our case, the patient presented signs and symptoms of unknown etiology that led to a re-evaluation of the previous ophthalmological diagnoses that the patient brought, finding that she had been treated for a diagnosis that did not match with all her clinical sign and symptoms and this helped us to find the real cause(AU)

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RESUMEN La rinosinusitis bacteriana aguda es la infección de la mucosa nasal y de senos paranasales, que se manifiesta con congestión nasal, rinorrea purulenta y fiebre, de curso generalmente autolimitado. La trombosis del seno cavernoso (TSC) es una complicación poco frecuente, que se asocia a compromiso del seno esfenoidal y etmoidal, manifestándose clínicamente con cefalea, fiebre, alteración de pares craneanos y síntomas oculares. Ante su sospecha el estudio imagenológico es fundamental. En estos exámenes se debe buscar un defecto de llene en el seno cavernoso comprometido. El tratamiento debe iniciarse de forma precoz y contempla: antibioticoterapia, drenaje quirúrgico del seno afectado y anticoagulación. Se presenta a un paciente pediátrico masculino con TSC derecha posterior a una rinosinusitis esfenoidal no tratada, que respondió favorablemente al tratamiento. Se describe la clínica y manejo de esta patología, que presenta alta morbimortalidad, y que puede disminuirse considerablemente con un tratamiento precoz y agresivo.

ABSTRACT Acute bacterial rhinosinusitis is the infection of the nasal and paranasal mucous membrane, with symptoms such as nasal congestion, purulent rhinorrhea and fever, usually self-limiting. Cavernous sinus thrombosis (CST) is a rare complication, which is associated with sphenoid and ethmoid sinus involvement, clinically manifest with headache, fever, cranial nerve involvement and ocular symptoms. When suspected, imaging studies will confirm the clinical impression. They will show abnormal flow parameters in the compromised cavernous sinus. The treatment has to start as soon as possible and consists in broad spectrum intravenous antibiotics, surgical drainage of the site of the infection and anticoagulation. We present a patient with a right CST secondary to a non-treated sphenoidal sinusitis, that responded favorably to treatment. The clinical and management of this pathology is described, which presents a high morbidity and mortality that can be reduced considerably with an early and aggressive treatment.