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Neuropediatrics 2013; 44(04): 191-198
DOI: 10.1055/s-0033-1338109
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Prediction of the Clinical Outcome of Cavernous Sinus Lesions in Children

Hana Leiba
1   Department of Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
2   Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
,
Gregor P. Jaggi
1   Department of Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
,
Eugen Boltshauser
3   Department of Paediatric Neurology, University Children's Hospital, Zurich, Switzerland
,
Klara Landau
1   Department of Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

14 September 2012

07 February 2013

Publication Date:
06 April 2013 (online)

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Abstract

To identify predictive findings in children with nontraumatic acquired cavernous sinus lesions, a retrospective study of the clinical course of 4 of our own patients and 17 more children found in an extensive literature search was performed. Mean age was 8.7 years. Malignancy was found in 11 of 21 children (6 female, 15 male). Of these 21 children, 9 were cured, 8 are either in remission or their course is unknown, and 4 died. Eight of the nine cured patients were diagnosed as having had Tolosa–Hunt syndrome. Of the four deceased children, three had a very short course (1 to 4 months) and were diagnosed with malignant lymphoma (n = 2) and rhabdomyosarcoma (n = 1). One patient died from a brain tumor other than the initially diagnosed T-cell lymphoma in the cavernous sinus after a follow-up of 8 years. MRI should be the preferred imaging technique—even if it is not conclusive in many cases—and every possible diagnostic effort should be made before using corticosteroids. No clinical or radiological signs other than rapid deterioration seem to be predictable of a malignant cavernous sinus lesion with poor outcome. Thus, close follow-up is recommended in children with signs and symptoms indicative of an acquired lesion in the cavernous sinus.

Keywords

cavernous sinus - headache - ophthalmoplegia - Tolosa–Hunt syndrome
 

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