Summary
Skull base syndromes are caused by malignancies or inflammatory conditions that affect the base of the skull and the cranial nerves exiting the skull. The location of the pathology can often be determined by characteristic features produced by nerve damage and other localizing space-occupying effects (e.g., pain, proptosis). Syndromes primarily involving the cranial nerves are discussed in a separate article (see cranial nerve palsies).
Superior orbital fissure syndrome
- Etiology: sphenoid wing meningioma; and rarely, trauma
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Clinical features
- Upper eyelid ptosis
- Proptosis of the eye
- Ophthalmoplegia
- Dilated and fixed pupil
- Loss of sensation of the upper eyelid and forehead due to damage to the trigeminal nerve
References:[1][2]
Foster-Kennedy syndrome
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Etiology
- Frontal lobe tumors, typically parasellar or subfrontal meningiomas
- Olfactory groove meningioma; : meningiomas arising from the cribriform plate and frontosphenoidal suture (see meningiomas)
- Clinical features
References:[3][4]
Orbital apex syndrome
- Etiology: damage to the orbital fissure or the optic canal resulting from an inflammatory condition or space-occupying lesion
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Clinical features
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Ophthalmoplegia
- Due to damage to the cranial nerves passing through the orbital fissure
- Partial/complete paresis of oculomotor nerve (IIIrdcranial nerve), trochlear nerve (IVthcranial nerve), and abducens nerve (VIthcranial nerve)
- Blindness
- Loss of sensation to the upper face may occur (see cranial nerve palsies).
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Ophthalmoplegia
References:[5][6][7]
Cavernous sinus syndrome
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Etiology
- Cavernous sinus thrombosis (e.g., due to sinusitis and contiguous spread of infection)
- Carotid-cavernous fistula
- Cavernous sinus tumors
- Pituitary tumors producing mass effect
- Carotid artery fistula or aneurysms
- Tolosa-Hunt syndrome (idiopathic granulomatous inflammation of the cavernous sinus)
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Clinical features
- Swelling of the conjunctiva
- Proptosis
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Signs of CN palsy due to compression (CN III, IV, V-1, V-2, and VI pass through the cavernous sinus)
- Painful ophthalmoplegia: partial/complete paresis of oculomotor nerve (third cranial nerve), trochlear nerve (fourth cranial nerve), and abducens nerve (sixth cranial nerve)
- Absent corneal reflex: paresis of the ophthalmic branch of the trigeminal nerve (V1)
- Loss of upper facial and corneal sensation may occur due to damage to the trigeminal branches of V1 and V2 (see cranial nerve disorders).
- Horner syndrome
References:[8]
Cerebellopontine angle syndrome
- Etiology: : most commonly vestibular schwannomas (acoustic neuroma), although other cerebellopontine angle tumors may result in the same presentation
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Clinical features
- Unilateral hearing loss
- Tinnitus
- Vertigo
- Headache
- Loss of facial sensation
References:[9]
Gradenigo's syndrome
- Etiology: complication of otitis media and mastoiditis that spreads to the petrous apex of the temporal bone, can also be tumor growth in the same area
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Clinical features: typical triad
- Lateral rectus palsy
- Retro-orbital pain
- Otorrhea (ear discharge)
References:[10]