Skip to main content

Advertisement

SpringerLink
Log in

Parasellar syndromes

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

The parasellar compartments are located lateral to and on either side of the sella turcica. The cavernous sinuses are the most prominent anatomic feature of the parasella. Each sinus consists of a plexus of veins through which runs the intracavernous portion of the internal carotid artery. Ocular motor nerves three and four travel within the dural covering of the cavernous sinus to the superior orbital fissure, and cranial nerve six travels through the carotid sinus itself, giving rise to parasellar syndromes, which have distinctive clinical features. Ophthalmoplegia occurs as a result of damage to these ocular motor nerves and variable involvement of oculosympathetic nerves. Facial pain, dysesthesia, and paraesthesia are caused by damage to one or more of the divisions of the fifth cranial nerve, travelling in the dural wall of the cavernous sinus. Tumors, such as meningiomas, frequently cause parasellar syndromes, as do aneurysms of the intracavernous portion of the internal carotid artery, carotid-cavernous fistulas, and cavernous sinus thrombosis. Inflammatory conditions such as Tolosa-Hunt syndrome, ischemia to small vessels supplying the cavernous portion of the cranial nerves, and infections can cause this syndrome. Magnetic resonance imaging is the investigation of choice and therapy is specific to the cause of the parasellar syndrome, but now includes more aggressive endoscopic and microsurgical intervention, and radiosurgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Nadalo LA, Easterbrook J, McArdle CB, Mendelsohn DB, Ponder TH: The neuroradiology of visual disturbances. Neurol Clin 1991, 9:1–33.

    PubMed  CAS  Google Scholar 

  2. Parkinson D: Lateral sellar compartment: history and anatomy. J Craniofac Surg 1995, 6:55–68.

    Article  PubMed  CAS  Google Scholar 

  3. Parkinson D: Carotid cavernous fistula: direct repair with preservation of the carotid artery. Technical note. J Neurosurg 1973, 38:99–106.

    PubMed  CAS  Google Scholar 

  4. Newman SA: The cavernous sinus. Neurosurg Clin North Am 1999, 10:731–757. Clinical features and physical examination skills are described in detail. Good review for the non-neuro-ophthalmologist.

    CAS  Google Scholar 

  5. Rhoton AL, Harris FS, Renn WH: Microsurgical anatomy of the sellar region and cavernous sinus. Clin Neurosurg 1976, 24:54–85.

    Google Scholar 

  6. Alfieri A, Jho HD: Endoscopic endonasal cavernous sinus surgery: an anatomic study. Neurosurgery 2001, 48:827–837. Clearly written, well-described, and illustrated anatomy of the parasellar region.

    Article  PubMed  CAS  Google Scholar 

  7. Inoue T, Rhoton AL, Theele D, Barry ME: Surgical approaches to the cavernous sinus: A microsurgical study. Neurosurgery 1990, 26:903–932.

    Article  PubMed  CAS  Google Scholar 

  8. Parkinson D: A surgical approach to the cavernous portion of the carotid artery: anatomical studies and case report. J Neurosurg 1965, 23:474–483.

    PubMed  CAS  Google Scholar 

  9. Lapresle J, Lasjaunias P: Cranial nerve ischaemic arterial syndromes: a review. Brain 1986, 109:207–215.

    Article  PubMed  Google Scholar 

  10. Capo H, Kupersmith MJ, Berenstein A, Choi IS, Diamond GA: The clinical importance of the inferolateral trunk of the internal carotid artery. Neurosurgery 1991, 28:733–738.

    Article  PubMed  CAS  Google Scholar 

  11. Thomas JE, Yoss RE: The parasellar syndrome: problems in determining etiology. Mayo Clin Proc 1970, 45:617–623.

    PubMed  CAS  Google Scholar 

  12. Swartz NG, Savino PJ: Clinical manifestations of lesions of the suprasellar and parasellar regions: a neuro-ophthalmologic perspective. Sem Ultrasound, CT and MRI 1993, 14:206–214.

    Article  CAS  Google Scholar 

  13. Jefferson G: On the saccular aneurysms of the internal carotid artery in the cavernous sinus. Br J Surg 1938, 26:267–301.

    Article  Google Scholar 

  14. Yoshihara M, Saito N, Kashima Y, Ishikawa H: The Ishikawa classification of cavernous sinus lesions by clinico-anatomical findings. Jpn J Ophthalmol 2001, 45:420–424.

    Article  PubMed  CAS  Google Scholar 

  15. Locksley HB: Natural history of subarachnoid, hemorrhage, intracranial aneurysms and arteriovenous malformation. J Neurosurg 1966, 25:219–239.

    PubMed  CAS  Google Scholar 

  16. Linskey MR, Sekhar LN, Hirsch Jr WL, Yonas H, Horton JA: Aneurysms of the intracavernous artery: natural history and indications for treatment. Neurosurgery 1990, 26:933–938.

    Article  PubMed  CAS  Google Scholar 

  17. Hahn CD, Nicolle DA, Lownie SP, Drake CG: Giant cavernous carotid aneurysms: clinical presentation in fifty-seven cases. J Neuro-ophthalmol 2000, 20:253–258.

    CAS  Google Scholar 

  18. Trobe JD, Glaser JS, Post JD: Meningiomas and aneurysms of the cavernous sinus: neuro-ophthalmologic features. Arch Ophthalmol 1978, 98:457–467.

    Google Scholar 

  19. Kupersmith MJ, Hurst R, Berenstein A, et al.: The benign course of cavernous carotid aneurysms. J Neurosurg 1992, 77:690–693.

    PubMed  CAS  Google Scholar 

  20. van der Schaaf IC, Brilstra EH, Buskens E, Rinkel GJ: Endovascular treatment of aneurysms in the cavernous sinus: a systematic review on balloon occlusion of the parent vessel and embolization with coils. Stroke 2002, 33:313–318. Review of 35 studies of endovascular treatment of aneurysms to date, with comparison between balloon occlusion and coils. Conclusions hampered by short follow-up time, but otherwise useful information.

    Article  PubMed  Google Scholar 

  21. Weir B: Pituitary tumors and aneurysms: case report and review of the literature. Neurosurgery 1992, 30:585–591.

    Article  PubMed  CAS  Google Scholar 

  22. Halbach VV, Hieshima GB, Higashida RT, Reicher M: Carotid cavernous fistulae: indications for urgent treatment. Am J Radiol 1987, 149:587–593.

    CAS  Google Scholar 

  23. Hu WY, Hudon M: Neuroimaging highlight: traumatic carotid-cavernous fistula. Can J Neurol Sci 2000, 27:71–72.

    PubMed  CAS  Google Scholar 

  24. Hiraamatsu K, Utsumi S, Kyoi K, et al.: Intracerebral hemorrhage in carotid-cavernous fistula. Neuroradiology 1991, 33:67–69.

    Article  Google Scholar 

  25. Dohrmann PJ, Batjer HH, Samson D, Suss RA: Recurrent subarachnoid hemorrhage complicating a traumatic carotid cavernous fistula. Neurosurgery 1985, 17:480–483.

    Article  PubMed  CAS  Google Scholar 

  26. Turner DM, VanGilder JC, Mojtahedi S, Pierson EW: Spontaneous intracerebral hematoma in carotid-cavernous fistula: report of three cases. J Neurosurg 1983, 59:680–686.

    PubMed  CAS  Google Scholar 

  27. Debrun G, Lacour P, Vinuela F, et al.: Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg 1981, 678–692.

  28. Weinstein JM, Rufenacht DA, Partington CR, et al.: Delayed visual loss due to trauma of the internal carotid artery. Arch Neurol 1991, 48:490–497.

    PubMed  CAS  Google Scholar 

  29. Lewis AI, Tomsick TA, Tew JMJr: Management of 100 consecutive direct carotid-cavernous fistulas: results of treatment using detachable balloons. Neurosurgery 1995, 36:239–245.

    Article  PubMed  CAS  Google Scholar 

  30. Lewis AI, Tomsick TA, Tew JMJr: Long-term results in direct carotid-cavernous fistulas after treatment with detachable balloons. J Neurosurg 1996, 84:400–404.

    Article  PubMed  CAS  Google Scholar 

  31. Newton TH, Hoyt WF: Dural arteriovenous shunts in the region of the cavernous sinus. Neuroradiology 1970, 1:71–81.

    Article  Google Scholar 

  32. Komiyama M, Fu Y, Yagura H, et al.: MR Imaging of dural AV fistulas at the cavernous sinus. J Comp Assist Tomography 1990, 14:397–401.

    Article  CAS  Google Scholar 

  33. Kline LB, Hoyt WF: The Tolosa-Hunt syndrome. J Neurol Neurosurg Psychiatry 2001, 71:577–582. Nicely written, current review of Tolosa-Hunt syndrome.

    Article  PubMed  CAS  Google Scholar 

  34. Ebright JR, Pace MT, Niazi AF: Septic thrombosis of the cavernous sinuses. Arch Intern Med 2001, 161:2671–2676.

    Article  PubMed  CAS  Google Scholar 

  35. Walsh FB: Clinical Neuro-ophthalmology. Baltimore: Williams and Wilkins; 1957:84.

    Google Scholar 

  36. Larson TL: Petrous apex and cavernous sinus: anatomy and pathology. Sem Ultrasound, CT and MRI 1993, 14:232–246.

    Article  CAS  Google Scholar 

  37. Levine SR, Twyman RE, Gilman S: The role of anticoagulation in cavernous sinus thrombosis. Neurology 1988, 38:517–522.

    PubMed  CAS  Google Scholar 

  38. Keane JR: Cavernous sinus syndrome. Analysis of 151 cases. Arch Neurol 1996, 53:967–971.

    PubMed  CAS  Google Scholar 

  39. Riskind PN: Case records of the Massachusetts General Hospital. Edited by Scully RE, Mark EJ, McNelly BU. N Engl J Med 1986, 314:229–238.

    Article  Google Scholar 

  40. Klink DF, Sampath P, Miller NR, Brem H, Long DM: Long-term visual outcome after nonradical microsurgery in patients with parasellar and cavernous sinus meningiomas. Neurosurgery 2000, 47:24–32. Good long-term follow-up study in patients with cavernous sinus meningiomas. Patient population is well described.

    Article  PubMed  CAS  Google Scholar 

  41. Wilson CB: Meningiomas: genetics, malignancy, and the role of radiation in induction and treatment. J Neurosurg 1994, 81:666–675.

    PubMed  CAS  Google Scholar 

  42. Duma CM, Lunsford LD, Kondziolka D, Harsh GR IV, Flickinger JC: Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery 1993, 32:699–705.

    Article  PubMed  CAS  Google Scholar 

  43. Liscak R, Simonova G, Vymazal J, Janouskova L: Gamma knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir (Wein) 1999, 141:472–480.

    Google Scholar 

  44. Shin M, Kurita H, Sasaki T, et al.: Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas. J Neurosurg 2001, 95:435–439.

    PubMed  CAS  Google Scholar 

  45. Iwai Y, Yamanaka K, Nakajma H: Two-staged gamma knife radiosurgery for the treatment of large petroclival and cavernous sinus meningiomas. Surg Neurol 2001, 56:308–314.

    Article  PubMed  CAS  Google Scholar 

  46. Chen JC, Giannotta SL, Yu C, et al.: Radiosurgical management of benign cavernous sinus tumors: dose profiles and acute complications. Neurosurgery 2001, 48:1022–1032.

    Article  PubMed  CAS  Google Scholar 

  47. Wray SH: Neuro-ophthalmologic manifestations of pituitary and parasellar lesions. Clin Neurosurg 1976, 24:86–117.

    Google Scholar 

  48. Weinberger LM, Adler GH, Grant FC: Primary pituitary adenoma and the syndrome of the cavernous sinus: a clinical and anatomic study. Arch Ophthalmol 1940, 24:1197–1236.

    Google Scholar 

  49. Robert CM, Feigenbaum JA, Sterm WE: Ocular palsy occurring with pituitary tumors. J Neurosurg 1973, 38:7–19.

    Google Scholar 

  50. Cardoso ER, Peterson EW: Pituitary apoplexy: a review. Neurosurgery 1984, 14:33–37.

    Article  Google Scholar 

  51. Wakai S, Fukushima T, Teramoto A, Sano K: Pituitary apoplexy: its incidence and clinical significance. J Neurosurg 1981, 55:187–193.

    Article  PubMed  CAS  Google Scholar 

  52. Reutens DC, Edis RH: Pituitary apoplexy presenting as aseptic meningitis without visual loss or ophthalmoplegia. Aust NZ J Med 1990, 20:590–591.

    CAS  Google Scholar 

  53. Weisberg LA: Pituitary apoplexy: association of degenerative change in pituitary adenoma with radiotherapy and detection by cerebral computed tomography. Am J Med 1977, 63:109–115.

    Article  PubMed  CAS  Google Scholar 

  54. Landau K, Goede D, Bründle M, Schmid C: Pituitary apoplexy revisited. North Am Neuro-Ophth Soc Abstracts 2002, 65.

  55. Inoue T, Fukui M, Matsushima T, Hasuo K, Matsunaga M: Neurinoma in the cavernous sinus: report of two cases. Neurosurgery 1990, 27:986–990.

    Article  PubMed  CAS  Google Scholar 

  56. Goel A, Muzumdar DP, Nitta J: Surgery on lesions involving cavernous sinus. J Clin Neursci 2001, 8(suppl 1):71–77.

    Article  Google Scholar 

  57. Kida Y, Kobayahshi T, Mori Y: Radiosurgery of cavernous hemangiomas in the cavernous sinus. Surg Neurol 2001, 56:117–123.

    Article  PubMed  CAS  Google Scholar 

  58. Godtfredsen E, Lederman M: Studies of the cavernous sinus syndrome. 2. Diagnostic and prognostic roles of ophthalmoneurological signs and symptoms in malignant nasopharyngeal tumors. Acta Neurol Scand 1965, 41:43–51.

    PubMed  CAS  Google Scholar 

  59. Post MJ, Mendez DR, Kline LB: Metastatic disease to the cavernous sinus: clinical syndrome and CT diagnosis. J Comput Assisted Tomography 1985, 9:111–120.

    Article  Google Scholar 

  60. Smith JL, Laxdal DS: Painful ophthalmoplegia: the Tolosa Hunt syndrome. Am J Ophthalmol 1966, 61:1466–1472.

    PubMed  CAS  Google Scholar 

  61. Tolosa E: Periarteritic lesions of the carotid siphon with the clinical features of a carotid infraclinoid aneurysm. J Neurol Neurosurg Psychiatry 1954, 17:300–302.

    PubMed  CAS  Google Scholar 

  62. Hunt WE, Meagher JN, LeFever HE, Zeman W: Painful ophthalmoplegia: its relation to indolent inflammation of the cavernous sinus. Neurology 1961, 11:56–62.

    PubMed  CAS  Google Scholar 

  63. Spector RH, Fiandaca MS: The "sinister" Tolosa-Hunt syndrome. Neurology 1986, 36:198–203.

    PubMed  CAS  Google Scholar 

  64. Averbuch-Heller L, Daroff RB: Painful ophthalmoplegias, Tolosa-Hunt syndrome and ophthalmoplegic migraine. In Headache. Edited by Goadsby PJ, Silberstein SD. Boston: Buttersworth-Heinemann; 1997:285–297.

    Google Scholar 

  65. Alvarex de Arcaya A, Cerezal L, Canga A, et al.: Neuroimaging diagnosis of Tolosa Hunt Syndrome: MRI contribution. Headache 1999, 39:321–325.

    Article  Google Scholar 

  66. Harano N, Behari S, Nagatani T, et al.: Idiopathic hypertrophic cranial pachymeningitis: Clincoradiological spectrum and therapeutic options. Neurosurgery 1999, 45:1336–1344.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Medicine, Ophthalmology, and Otolaryngology, University of Manitoba, 706-233 Kennedy Street, R3C 3J5, Winnipeg, Manitoba, Canada

    Janine L. Johnston MD, FRCPC

Authors
  1. Janine L. Johnston MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Johnston, J.L. Parasellar syndromes. Curr Neurol Neurosci Rep 2, 423–431 (2002). https://doi.org/10.1007/s11910-002-0069-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-002-0069-3

Keywords

Search

Navigation