Abstract: From 1973 to 1982, 189 patients were treated at the Dartmouth-Hitchcock Medical Center for Stage C or D prostatic carcinoma. In eight of these cases (4.2%), there was clinical or pathological evidence for intracranial metastases. The condition of subdural neoplastic spread, not from contiguous bone, was identified in five cases, two of which were suspected before death. Four of these five patients were thrombocytopenic or pancytopenic at the time of the diagnosis. Intraparenchymal brain metastases were identified in six cases. Cerebellar, temporal bone, cavernous sinus, and splenium infiltration by tumor were unusual findings in individual cases. The results of chest x-rays and respiratory status were poor predictors of lung metastases in four of five patients on whom autopsies were performed. This article describes the spectrum of radiographic and pathologic findings of intracranial prostatic carcinoma, and suggests that the likely mechanism of brain metastasis in these cases is by the dural veins and Virchow-Robin spaces.

Abstract: The goal of therapy in patients with traumatic carotid-cavernous fistulas is to occlude the fistula, preferably while maintaining the carotid blood flow. Surgical techniques that treat the fistula remote from the cavernous sinus often cannot maintain carotid patency. Various interventional techniques using detachable balloons have been developed. The most common technique uses the endarterial route, introducing the balloon catheter in the neck or the groin. If the balloon is detached in the cavernous sinus, the carotid blood flow will be preserved. A second approach uses the venous retrograde route through the jugular vein, inferior petrosal sinus, and cavernous sinus. Elegant and safe, this method is appropriate when the fistula drains posteriorly. A third approach involves surgical exposure of the cavernous sinus and direct introduction of the balloon. This is sometimes the only recourse when the fistula has been previously treated with internal carotid ligation.

Abstract: • A patient had angiographie and computed tomographic features of a dissecting aneurysm of the extracranial internal carotid artery, with intracranial extension into the cavernous sinus. Isolated abducens nerve palsy resolved without treatment, within a two-month period.

Abstract: Carotid-cavernous fistulas may be classified into: (1) internal carotid, (2) external carotid, or (3) a combination of both. They may result from traumatic or spontaneous rupture of the carotid artery into the cavernous sinus. Intravascular embolization has become the treatment of choice for the management of carotid cavernous fistulas. The authors report the delayed effects after the treatment of carotid-cavernous fistulas with experience of 74 cases over the past 6 years. The delayed effects may be summarized as follows: (1) progressive spontaneous occlusion of the fistula after partial balloon embolization, (2) false aneurysms may decrease in size and be spontaneously sealed off, (3) transient and persistent third or sixth cranial nerve palsy may be seen in about 16% of 74 cases, (4) posttraumatic fibrosis with narrowing of the carotid artery may be apparent after total occlusion of the fistula, (5) a prematurely deflated balloon may be dislodged into the carotid artery or its branch, and (6) spontaneous obliteration of common channels from internal carotid artery may occur after total occlusion of external carotid channels in those cases with a combination of internal carotid- and external carotid-cavernous fistulas. Certainly the delayed effect will alter our future planning in the treatment of carotid cavernous fistulas.

Abstract: ✓ A spontaneous cavernous sinus fistula developed following presumed sinusitis, and was found to originate not from the carotid artery but from a persistent trigeminal artery. The fistula was treated by introducing a detachable latex balloon via a femoral artery approach through the trigeminal artery and then into the cavernous sinus. Flow through the carotid, vertebral, and trigeminal arteries was preserved.

Abstract: Fourteen patients with angiographically-proven carotid-cavernous fistulas were evaluated by computed tomography (CT). Unilateral or bilateral exophthalmos was noted in 12 patients. Slight blurring of the margin of the globe was present in two, presumably due to pulsations of the globe or conjunctival edema. Superior ophthalmic veins were prominent in 12 patients and were often larger on the side of the fistula. Irregularity or absence of contrast enhancement of the superior ophthalmic vein may indicate partial or complete thrombosis. Focal bulging or diffuse distention of the cavernous sinus was noted in nine patients. Enlargement of the extraocular muscles was observed in seven with swelling of the eyelids and edema of the conjunctiva in eight patients. The pattern of venous drainage, type of fistula, and time intervals between trauma, commencement of fistula, and CT scan may affect the CT manifestations of carotid-cavernous fistulas.

Abstract: Two cases of carotid-cavernous fistulas were successfully treated by standard interventional radiology techniques after otherwise inaccessible vessels were surgically exposed In the first case, an internal carotid artery (ICA), which had previously been ligated as part of an attempted surgical "entrapment" procedure, was recanalized to permit passage of a detachable balloon catheter to the fistula, resulting in its obliteration In the second case, an enlarged superior ophthalmic vein was exposed and isolated to facilitate retrograde catheterization of the cavernous sinus and obliteration of a dural fistula between the ICA and the cavernous sinus by steel Gianturco coils The methods and complications of both procedures are discussed

Abstract: THE NORMAL internal carotid artery enters the base of the skull through the carotid canal. The artery then bends medially and anteriorly, traversing the petrous bone and cavernous sinus, before emerging medial to the anterior clinoid process. As it passes through the bony petrous ridge, the artery is separated from the middle ear cavity by the tympanic plate. This 0.5-mm-thick plate may be disrupted in basilar skull fractures, displacing the carotid artery into the middle ear. The artery may also pass through the middle ear because of congenital anomalies in its course. Such a vessel may be seen through the tympanic membrane, where it may be mistaken for hemorrhage behind the drum or a tumor. The vessel may be injured during myringotomy; attempts to perform a biopsy of the "mass" may be disastrous. We recently treated a child who experienced massive hemorrhage from his ear after biopsy of such a

Abstract: The authors report their experience with five patients presenting with cavernous sinus syndrome who, on computerized tomography (CT) studies, were shown to have a lesion simultaneously involving the cavernous sinus and a portion of the orbit. All patients underwent an orbital fine-needle aspiration biopsy (FNAB). A specific cytological diagnosis was made in three of the five patients. To obtain pathological diagnosis in the case of cavernous sinus tumors, invasive diagnostic procedures are sometimes necessary. Extension of lesions from the cavernous sinus into adjacent areas should be carefully looked for on CT scans. In the specific subset of patients with cavernous sinus tumors and simultaneous orbital involvement, orbital FNAB may provide a simple alternative to more invasive procedures. The limitations of the procedure are discussed.

Abstract: ✓ A complication of treatment of posttraumatic carotid-cavernous fistulas by detachable balloon techniques is presented. During occlusion of the fistula, a balloon embolus migrated from the cavernous sinus into the bifurcation of the internal carotid artery. The resultant neurological deficit was immediately treated with hypertension and volume expansion. The patient underwent direct microsurgical embolectomy and suffered no postoperative neurological sequelae. The significance and management of this complication are discussed.

Abstract: All patients between 1977 and 1982 who presented with unilateral exophthalmos were evaluated with contact B-scan ultrasonography Of these, eight patients were diagnosed as having retro-orbital or orbital arteriovenous anomalies (two carotidcavernous sinus fistulas, four dural arteriovenous malformations, and two orbital arteriovenous malformations) On B-scan ultrasound, all of these patients demonstrated a dilated superior ophthalmic vein None of the other patients with unilateral proptosis demonstrated this finding With recent advances in treatment of these conditions, early diagnosis becomes increasingly important Contact B-scan ultrasonography (which is widely available, convenient, and expedient) can be used for early diagnosis of arteriovenous anomalies in the orbit and cavernous sinus areas Other ultrasonic techniques such as A-scan, standardized A-scan, or immersion B-scan, are equally reliable in the recognition of a dilated superior orbital vein In the authors' opinion, however, these are less convenient, more time consuming, and require more expertise for similar results

Abstract: We report a case of cavernous sinus syndrome associated with non-Hodgkin's lymphoma of the ethmoid sinus. The tumour involved the right ethmoid sinus and partially affected the sphenoidal and right maxillary antrum. The presentation was atypical. We discuss the histological findings and present a brief review of the literature.

Abstract: Three cases of painful ophthalmoplegia with acute onset due to an unruptured aneurysm of the intracavernous portion of the internal carotid artery are reported. The possible pathogenetic mechanisms responsible for this unusual mode of clinical manifestation are discussed and the neurovascular relationships of the cavernous sinus are analyzed in respect of ischemic versus compressive damage to the intracavernous neural structures.

Abstract: A case of localized cranial Wegener granulomatosis was imaged with high resolution computed tomography. The mass extended from the infratemporal fossa, through the basal foramina, and into the cavernous sinus, causing complete occlusion of the internal carotid artery. Computed tomography demonstrated absence of bone destruction and a normal parotid gland and nasopharynx. Although uncommon, Wegener granulomatosis should be considered in the differential diagnosis of a parapharyngeal mass with intracranial extension.

Abstract: ✓ Pulsatile exophthalmos in association with carotid-cavernous sinus fistulas has been well defined anatomically, by angiography. This paper presents the physiological assessment of this entity, as measured with ocular pneumoplethysmography (OPG-Gee). The abnormal arteriovenous communication lowers resistance to arterial flow. This is characterized by a lowered ophthalmic systolic pressure and an increased ocular blood flow. The OPG readily documents the physiological result of therapeutic intervention.

Abstract: A 16-year-old boy was found to have a cavernous sinus syndrome secondary to rhabdomyosarcoma originating in the masseter muscle. Radiologic studies showed evidence of dissemination to the cavernous sinus without involvement of the skull base or its foramina. Despite aggressive therapy with transient improvement of his ocular palsy, the patient died within 16 months after the onset of his illness. Neuro-ophthalmic complications often develop as a result of direct extension from rhabdomyosarcoma originating in the head and neck region. However, to the best of our knowledge, this is the first report of a cavernous sinus syndrome caused by metastasis from rhabdomyosarcoma.

Abstract: Five patients with caroticocavernous fistula were treated by new, interventional angiographic techniques. In four patients, latex balloons filled with a silicone polymer were introduced into the cavernous sinus via the transfemoral route and detached; this resulted in complete obliteration of the caroticocavernous fistula and preservation of the internal carotid artery flow in two of the four patients. In the fifth patient, stainless steel coils were introduced into the cavernous sinus via the superior ophthalmic vein which had previously been surgically exposed. These percutaneous, angiographic techniques of intervention should be considered the initial treatment of choice for caroticocavernous fistulae.

Abstract: The classification of the cranial dural fistulas depends from the topography of the pathological part of the sinus. The main and most frequent fistulas concern: cavernous and intercavernous sinus; superior sagittal sinus; lateral sinus. The fistulas of the cavernous sinus are always multipedicular. The embolization is the best treatment with very small pieces of dura, because Isobutyl is sometimes dangerous in such a localization. The most frequent fistulas are localized on the lateral sinus; the best treatment is embolization but the long-term results are irregular and a complete anatomical cure is rare. The fistulas of the superior sagittal sinus are less frequent and are often fistulas with cortical vein drainage. The best treatment seems embolization with IBC; when there is a cortical vein drainage, a neurosurgical intervention is better.

Abstract: Secondary vascular glaucoma is increased intraocular pressure due to venous obstruction in or outside the eye. Its main aetiological features are lesions of the vortex veins and the anterior ciliary veins and orbital and cavernous sinus obstruction; increase in orbital volume, tenonitis/scleritis posterior and idiopathically elevated episcleral venous pressure are described.

Abstract: An 18-year-old female was admitted following an automobile accident. She was confused and the left pupil was not reactive to light. Plain skull films and tomograms of the skull revealed a left frontal linear, vertical, skull fracture extending to the floor of the anterior fossa and the lateral aspect of the orbit. Blindness of the left eye was found, when the patient became alert. Five days later, left third, fourth and sixth-nerve palsies were noted. The patient became aphasic and right hemiparetic. A computerized tomography scan revealed a slightly low density area in the left fronto-temporal region and a round contrast-enhancing mass in the left cavernous sinus region. A left internal carotid angiogram showed a large aneurysm, 8×9×13 mm in size, in the cavernous portion and an early venous filling in the region of the frontal branches of the middle cerebral artery. Aphasia and the right hemiparesis gradually improved. Repeated angiography demonstrated a marked enlargement of the aneurysm despite a daily, Matas test maneuver. Surgery identified a lacerated optic nerve and fracture of the planum sphenoidale. The aneurysm was partially obliterated by copper wire thrombosis. One month after surgery, paralysis of the oculomotor and abducens nerves completely recovered.

Abstract: ✓ A new instrument is described which allows easy and precise bipolar coagulation of the anterior intercavernous sinus. In some cases this sinus covers the anterior aspect of the pituitary and may render transsphenoidal pituitary surgery difficult.

Abstract: The venous drainage dynamics of the cavernous sinus were studied by means of 50 carotid angiograms and 18 orbital phlebographies performed on 47 patients with various tumours of the sellar area. Normal blood flow direction in the superior ophthalmic vein (SOV) (from the facial veins into the cavernous sinus) was seen in supra- and small intrasellar tumours, but not in parasellar tumours. In bigger intrasellar tumours and in parasellar tumours the reversed blood flow direction visible in the SOV (from the cavernous sinus into the facial veins) indicated infiltration or compression of the cavernous sinus by tumour. The sign of reversed flow together with CT findings is useful in differential diagnosis and in planning surgical treatment for tumours of the sellar area.

Abstract: A simple method using standard computed tomography (CT) and stereotactic equipment is described, enabling us to take biopsies from orbital lesions at predetermined sites. The method is characterized by high accuracy, because it avoids the uncertainty inherent in free-hand needle aspiration. It gives more diagnostic safety by providing larger samples.