The Tolosa-Hunt Syndrome—Literature Review: Seven New Cases and a Hypothesis

Hoes, M.J.A.J.M.; Bruyn, G.W.; Vielvoye, G. J.

doi:10.1046/j.1468-2982.1981.0104181.x

Cited by 17 publications

(11 citation statements)

References 48 publications

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“…[2,4,6,11,15,19,46] These often require neurosurgical interventions, [33][34][35][36] treatment using invasive radiological techniques, [1,5,29,40] or radiotherapy. [7,9] All manipulations within this narrow space require an exact knowledge of the particular parasellar topography in infants.…”

Section: Objectmentioning

confidence: 99%

The parasellar region of human infants: cavernous sinus topography and surgical approaches

Weninger¹,

Mülle²

1999

FOC

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Object In this study the authors analyze the peculiarities of the parasellar anatomy and the topography of surgical approaches to the parasellar region (PSR) in human infants. Methods Forty-nine specimens of the PSR obtained at autopsy were studied using microdissection and histological analysis. Important distances between anatomical landmarks were measured with the aid of a dissecting microscope. One serially sectioned specimen was three-dimensionally reconstructed and analyzed on the computer screen by using the authors' new episcopic reconstruction technique. The anatomy of the infant PSR differs distinctly from that of the adult. The parasellar portion of the internal carotid artery (ICA) does not form a siphon, but takes a straight course, and the venous pathways as well as the cranial and sympathetic nerves have different topographical relationships. Analyses of surgical approaches demonstrate that, in young children, the anterolateral approach can be used to reach the pterygopalatine compartment, the superior ophthalmic vein, and those pathological processes that extend from the orbit into the PSR. The approach via Parkinson's triangle can be used in 45% of cases to access the pathological processes that occur in the voluminous space above and behind the posterior flexure of the parasellar ICA. Taking this route, sympathetic nerve fibers passing through the PSR are not at risk, but some arterial branches that run within the lateral wall of the sinus can complicate this approach. Conclusions This study presents a guideline that can assist radiologists and neurosurgeons in the planning and performance of interventions within the PSR of neonates and young children.

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Section: Objectmentioning

confidence: 99%

The parasellar region of human infants: cavernous sinus topography and surgical approaches

Weninger¹,

Mülle²

1999

FOC

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“…18,19), which can be visualized on venography. These changes are most often on the side of the painful ophthalmoplegia, but they may be bilateral.…”

Section: Orbital Venous Vasculitis and Cluster Headachementioning

confidence: 99%

Cluster Headache: The Possible Significance of Midline Structures

Sjaastad¹

1988

Cephalalgia

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The pathogenesis of cluster headache is unknown (see, for example, Ref. 1). With regard to the main component of cluster headache, the pain itself, little information exists both as to the origin and as to the nature of the pain. Existing theories concerning cluster headache pathogenesis have been rather unproductive. In the following, evidence from seemingly totally unrelated fields that, nevertheless, possibly has a bearing on cluster headache pathogenesis will be reviewed. On the tendency to bilaterality in cluster headacheCluster headache is in principle a unilateral headache. There is, however, a tendency for the headache to shift side, either during one single bout (circa 5%) or from one bout to another (circa 10%). All in all, approximately 15% of cluster headache cases thus shift side at some point along the time axis (2). Accordingly, there seems to be a "disposition" or "anlage" for the headache to develop on both sides in cluster headache, although the headache actually most frequently manifests itself on one side only.The prevalence of cluster headache in the form that is severe enough to lead to medical consultations may seem to be around 0.7% (3) in Western countries. The tendency to develop headache on the side opposite the pain side in a cluster headache patient may, therefore, seem to be around 200 times higher than for an individual to develop this type of headache de novo (4). Side shift is thus a conspicuous feature of this disease.On rare occasions, the headache may even be bilateral (5). Several variations of bilaterality have also been observed. Ekbom (6) has thus described a case with a most peculiar pattern, in which the headache during one bout, in addition to appearing on the original side, started appearing on the contralateral side; then "the headache shifted [side] in different attacks"; thereafter, a decrescendo occurred on the original side as opposed to a crescendo on the contralateral side, and, in the ultimate phase, attacks only appeared on the contralateral side.After operations on one side, pain attacks have a tendency to recur on the opposite, previously pain-free side. This was thus the case in 1 of 12 cases treated with the "combined procedure"-that is, sectioning of the greater superficial petrosal nerve and neurolysis of the sensory root of the trigeminal nerve (7).The attack of cluster headache as such consists of (at least) two components: the pain and the autonomic phenomena. The latter also show a tendency to bilaterality (8, 9) and, in fact, much more regularly so than does the pain. In patients with side shift there is sometimes a dichotomy between pain and autonomic phenomena, the latter persisting on the previous pain side (4). The schism may even be primary; that is, the pain has always been contralateral to the autonomic phenomena (10).This tendency to bilaterality in cluster headache is intriguing. A pathogenetic model of cluster headache must also include and explain the marked tendency to bilaterality of the pain and, above all, of the autonomic manifestati...

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“…Knowledge of the composition and topography of the PSR and orbital apex provide for accurate radiological diagnosis of the various pathologies affecting the entire region. For example it is the basis for distinguishing harmless adipose tissue occupying the parasellar compartments from adipose tissue associated with an angiolipoma, and may help in the diagnosis of lesions that cause orbital apex, superior orbital fissure, anterior cavernous sinus, and Tolosa-Hunt syndrome (Hoes et al, 1981;Kline, 1982;Bachow et al, 1984;Slavin and Abramson, 1986;Wilkins et al, 1987;Gross et al, 1989;Drevelengas et al, 1993;De Keizer et al, 1997). Furthermore, preinterventional knowledge of the individual size and topography of the compartments aids in carrying out radiological interventions, such as CT-controlled transorbital fine needle biopsies (Rowed et al, 1985).…”

Section: Discussionmentioning

confidence: 99%

In vivo 3D analysis of the adipose tissue in the orbital apex and the compartments of the parasellar region

Weninger

Prokop

2004

Clinical Anatomy

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As tissue dissections carried out on formaldehyde-fixed anatomical specimens demonstrate, the parasellar region (PSR), traditionally referred to as the cavernous sinus, is composed of three distinct compartments: orbital, pterygopalatine, and lateral sellar. The aim of our study was to identify and measure these compartments in the living and to describe the topography of their adipose body tissues. For this purpose data sets of 35 patients, who had undergone thin-section multislice computed tomography (CT), were examined using 3D-reconstruction software. The pterygopalatine and orbital compartments of the PSR could be identified in the images by their adipose bodies. We provide more exacting measurements of their size than have been presented in earlier studies. Furthermore, we include data about the uni- and bilateral presence of the single compartments and analyze the topography of the adipose tissue bodies in the orbital apex region. Our quantitative data and topographical descriptions confirm the compartmentalization concept of the PSR, allow for correct interpretation of CT scans of the orbital apex and anterior PSR, and provide baseline information for individual planning of surgical and radiological interventions.

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The Tolosa-Hunt Syndrome—Literature Review: Seven New Cases and a Hypothesis

Cited by 17 publications

References 48 publications

The parasellar region of human infants: cavernous sinus topography and surgical approaches

The parasellar region of human infants: cavernous sinus topography and surgical approaches

Cluster Headache: The Possible Significance of Midline Structures

In vivo 3D analysis of the adipose tissue in the orbital apex and the compartments of the parasellar region

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