The most characteristic symptoms of lesions in the cavernous sinuses are ophthalmoplegia, orbital congestion, and proptosis. Cavernous sinus tumors Cavernous sinus tumors are the most common cause of cavernous sinus syndrome. Examples include metastatic lesions from nasopharyngeal carcinomas and breast, prostate, and lung cancer. Radiotherapy may offer transient relief, particularly in nasopharyngeal cancer. Lateral extension of pituitary tumors may be treated with surgical resection and dopamine agonists in the case of prolactinoma.
Primary tumors are most commonly meningiomas and neurofibromas.
Total resection of these lesions is challenging and attempted only when the symptoms are disabling. Unlike intracranial aneurysms in other anatomic locations, carotid-cavernous aneurysms do not involve a major risk of subarachnoid hemorrhage. However, their rupture results in direct C-C fistulas. These aneurysms, which are more frequent in the elderly population, present with an indolent ophthalmoplegia. Although some patients suffer minor disability and do not require treatment, endovascular occlusion of these lesions is often successful and may be tried in selected patients.