Parasellar syndromes |
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Authors: | Johnston Janine L |
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Institution: | (1) Departments of Medicine, Ophthalmology, and Otolaryngology, University of Manitoba, 706-233 Kennedy Street, R3C 3J5 Winnipeg, Manitoba, Canada |
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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. |
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Keywords: | |
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