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Copyright (c) 2025 Mobarak Fahad Mobarak Aldossari, Mohammed Mesfer Mohammed Aldawsari, Ahmad Talal Matar Almarshadi, Minahi Fehaid Musaibeeh Alotaibi, Ahmed Alsulayyih, Saber Hamed Maqbul Alsharari, Naji Mohammed Saleh Al-Qahtani, Hassan Mohammed Mohammed Tomihi, Fares Zaban Alrowiliy, Youssef Farhan H Alsharari, Hassan Mohammed Mohammed Tomihi, Huda Yahya Albeshi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Multidisciplinary Management of Cavernous sinus thrombosis: Early Recognition, Rapid Response, and Integrated Hospital Care Pathways-An Updated Review
Corresponding Author(s) : Mobarak Fahad Mobarak Aldossari
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Cavernous sinus thrombosis (CST) is a rare but life-threatening cerebrovascular disorder most often arising from septic spread of infections in the facial, sinus, orbital, or dental regions. Its rapid progression, involvement of critical neurovascular structures, and potential for severe neurological deficits necessitate prompt clinical recognition and multidisciplinary management.
Aim: This review aims to provide an updated, integrated overview of CST, focusing on early recognition, diagnostic approaches, and comprehensive inpatient management strategies to improve clinical outcomes.
Methods: A narrative review methodology was used, synthesizing current evidence on CST etiology, epidemiology, pathophysiology, clinical presentation, diagnostic imaging, and therapeutic interventions. Sources include retrospective studies, expert consensus, and observational data due to the absence of randomized clinical trials.
Results: CST predominantly originates from infections in the nasolabial triangle, paranasal sinuses, or orbit, with Staphylococcus aureus representing the most common pathogen. Clinical manifestations include fever, severe headache, periorbital edema, ophthalmoplegia, and cranial nerve dysfunction. Contrast-enhanced CT or MR venography is essential for diagnosis. Management centers on aggressive broad-spectrum antimicrobial therapy and anticoagulation, with surgical intervention reserved for drainage of primary infectious sources. Contemporary treatment has significantly reduced mortality to approximately 8–13%, although long-term sequelae such as visual impairment and persistent cranial nerve deficits remain common.
Conclusion: Early diagnosis combined with prompt antimicrobial therapy, carefully selected anticoagulation, and multidisciplinary care is essential for improving CST outcomes. Continued clinical vigilance and standardized management pathways are critical to minimizing morbidity.
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- Matthew TJH, Hussein A. Atypical Cavernous Sinus Thrombosis: A Diagnosis Challenge and Dilemma. Cureus. 2018 Dec 04;10(12):e3685.
- Eltayeb AS, Karrar MA, Elbeshir EI. Orbital Subperiosteal Abscess Associated with Mandibular Wisdom Tooth Infection: A Case Report. J Maxillofac Oral Surg. 2019 Mar;18(1):30-33.
- Dolapsakis C, Kranidioti E, Katsila S, Samarkos M. Cavernous sinus thrombosis due to ipsilateral sphenoid sinusitis. BMJ Case Rep. 2019 Jan 29;12(1)
- Chen MC, Ho YH, Chong PN, Chen JH. A rare case of septic cavernous sinus thrombosis as a complication of sphenoid sinusitis. Tzu Chi Med J. 2019 Jan-Mar;31(1):63-65.
- Kasha S, Bandari G. Bilateral Posterior Fracture-Dislocation of Shoulder Following Seizures Secondary to Cavernous Sinus Venous Thrombosis - A Rare Association. J Orthop Case Rep. 2018 Jul-Aug;8(4):49-52.
- DiNubile MJ. Septic thrombosis of the cavernous sinuses. Arch Neurol. 1988 May;45(5):567-72.
- Dinkin M, Patsalides A, Ertel M. Diagnosis and Management of Cerebral Venous Diseases in Neuro-Ophthalmology: Ongoing Controversies. Asia Pac J Ophthalmol (Phila). 2019 Jan-Feb;8(1):73-85.
- Torretta S, Guastella C, Marchisio P, Marom T, Bosis S, Ibba T, Drago L, Pignataro L. Sinonasal-Related Orbital Infections in Children: A Clinical and Therapeutic Overview. J Clin Med. 2019 Jan 16;8(1)
- Darmawan G, Hamijoyo L, Oehadian A, Bandiara R, Amalia L. Cerebral Venous Sinus Thrombosis in Systemic Lupus Erythematosus. Acta Med Indones. 2018 Oct;50(4):343-345.
- Mulvey CL, Kiell EP, Rizzi MD, Buzi A. The Microbiology of Complicated Acute Sinusitis among Pediatric Patients: A Case Series. Otolaryngol Head Neck Surg. 2019 Apr;160(4):712-719.
- Housley SB, McPheeters MJ, Raygor KP, Bouslama M, Scullen T, Davies JM. Cavernous Sinus Thrombosis. Neurosurg Clin N Am. 2024 Jul;35(3):305-310.
- Weerasinghe D, Lueck CJ. Septic Cavernous Sinus Thrombosis: Case Report and Review of the Literature. Neuroophthalmology. 2016 Dec;40(6):263-276.
- Neal TW, Schlieve T. Complications of Severe Odontogenic Infections: A Review. Biology (Basel). 2022 Dec 08;11(12)
- Alam MS, Backiavathy V, Noronha V, Mukherjee B. Orbital abscess: 20 years' experience at a tertiary eye care center. Orbit. 2022 Dec;41(6):751-758.
- Berge J, Louail C, Caillé JM. Cavernous sinus thrombosis diagnostic approach. J Neuroradiol. 1994 Apr;21(2):101-17.
- Branson SV, McClintic E, Yeatts RP. Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis: A Report of 6 Cases and Review of Literature. Ophthalmic Plast Reconstr Surg. 2019 May/Jun;35(3):272-280.
- Deliran SS, Sondag L, Leijten QH, Tuladhar AM, Meijer FJA. [Headache: consider cavernous sinus thrombophlebitis]. Ned Tijdschr Geneeskd. 2018 Aug 16;162
- Fujikawa T, Sogabe Y. Septic cavernous sinus thrombosis: potentially fatal conjunctival hyperemia. Intensive Care Med. 2019 May;45(5):692-693.
- van der Poel NA, de Witt KD, van den Berg R, de Win MM, Mourits MP. Impact of superior ophthalmic vein thrombosis: a case series and literature review. Orbit. 2019 Jun;38(3):226-232.
- Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 2006 Oct;26 Suppl 1:S19-41; discussion S42-3.
- Akarapas C, Wiwatkunupakarn N, Sithirungson S, Chaiyasate S. Anticoagulation for cavernous sinus thrombosis: a systematic review and individual patient data meta-analysis. Eur Arch Otorhinolaryngol. 2025 Mar;282(3):1127-1134.
- Wang YH, Chen PY, Ting PJ, Huang FL. A review of eight cases of cavernous sinus thrombosis secondary to sphenoid sinusitis, including a12-year-old girl at the present department. Infect Dis (Lond). 2017 Sep;49(9):641-646.
- Frank GS, Smith JM, Davies BW, Mirsky DM, Hink EM, Durairaj VD. Ophthalmic manifestations and outcomes after cavernous sinus thrombosis in children. J AAPOS. 2015 Aug;19(4):358-62. [
- Caranfa JT, Yoon MK. Septic cavernous sinus thrombosis: A review. Surv Ophthalmol. 2021 Nov-Dec;66(6):1021-1030.
References
Matthew TJH, Hussein A. Atypical Cavernous Sinus Thrombosis: A Diagnosis Challenge and Dilemma. Cureus. 2018 Dec 04;10(12):e3685.
Eltayeb AS, Karrar MA, Elbeshir EI. Orbital Subperiosteal Abscess Associated with Mandibular Wisdom Tooth Infection: A Case Report. J Maxillofac Oral Surg. 2019 Mar;18(1):30-33.
Dolapsakis C, Kranidioti E, Katsila S, Samarkos M. Cavernous sinus thrombosis due to ipsilateral sphenoid sinusitis. BMJ Case Rep. 2019 Jan 29;12(1)
Chen MC, Ho YH, Chong PN, Chen JH. A rare case of septic cavernous sinus thrombosis as a complication of sphenoid sinusitis. Tzu Chi Med J. 2019 Jan-Mar;31(1):63-65.
Kasha S, Bandari G. Bilateral Posterior Fracture-Dislocation of Shoulder Following Seizures Secondary to Cavernous Sinus Venous Thrombosis - A Rare Association. J Orthop Case Rep. 2018 Jul-Aug;8(4):49-52.
DiNubile MJ. Septic thrombosis of the cavernous sinuses. Arch Neurol. 1988 May;45(5):567-72.
Dinkin M, Patsalides A, Ertel M. Diagnosis and Management of Cerebral Venous Diseases in Neuro-Ophthalmology: Ongoing Controversies. Asia Pac J Ophthalmol (Phila). 2019 Jan-Feb;8(1):73-85.
Torretta S, Guastella C, Marchisio P, Marom T, Bosis S, Ibba T, Drago L, Pignataro L. Sinonasal-Related Orbital Infections in Children: A Clinical and Therapeutic Overview. J Clin Med. 2019 Jan 16;8(1)
Darmawan G, Hamijoyo L, Oehadian A, Bandiara R, Amalia L. Cerebral Venous Sinus Thrombosis in Systemic Lupus Erythematosus. Acta Med Indones. 2018 Oct;50(4):343-345.
Mulvey CL, Kiell EP, Rizzi MD, Buzi A. The Microbiology of Complicated Acute Sinusitis among Pediatric Patients: A Case Series. Otolaryngol Head Neck Surg. 2019 Apr;160(4):712-719.
Housley SB, McPheeters MJ, Raygor KP, Bouslama M, Scullen T, Davies JM. Cavernous Sinus Thrombosis. Neurosurg Clin N Am. 2024 Jul;35(3):305-310.
Weerasinghe D, Lueck CJ. Septic Cavernous Sinus Thrombosis: Case Report and Review of the Literature. Neuroophthalmology. 2016 Dec;40(6):263-276.
Neal TW, Schlieve T. Complications of Severe Odontogenic Infections: A Review. Biology (Basel). 2022 Dec 08;11(12)
Alam MS, Backiavathy V, Noronha V, Mukherjee B. Orbital abscess: 20 years' experience at a tertiary eye care center. Orbit. 2022 Dec;41(6):751-758.
Berge J, Louail C, Caillé JM. Cavernous sinus thrombosis diagnostic approach. J Neuroradiol. 1994 Apr;21(2):101-17.
Branson SV, McClintic E, Yeatts RP. Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis: A Report of 6 Cases and Review of Literature. Ophthalmic Plast Reconstr Surg. 2019 May/Jun;35(3):272-280.
Deliran SS, Sondag L, Leijten QH, Tuladhar AM, Meijer FJA. [Headache: consider cavernous sinus thrombophlebitis]. Ned Tijdschr Geneeskd. 2018 Aug 16;162
Fujikawa T, Sogabe Y. Septic cavernous sinus thrombosis: potentially fatal conjunctival hyperemia. Intensive Care Med. 2019 May;45(5):692-693.
van der Poel NA, de Witt KD, van den Berg R, de Win MM, Mourits MP. Impact of superior ophthalmic vein thrombosis: a case series and literature review. Orbit. 2019 Jun;38(3):226-232.
Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 2006 Oct;26 Suppl 1:S19-41; discussion S42-3.
Akarapas C, Wiwatkunupakarn N, Sithirungson S, Chaiyasate S. Anticoagulation for cavernous sinus thrombosis: a systematic review and individual patient data meta-analysis. Eur Arch Otorhinolaryngol. 2025 Mar;282(3):1127-1134.
Wang YH, Chen PY, Ting PJ, Huang FL. A review of eight cases of cavernous sinus thrombosis secondary to sphenoid sinusitis, including a12-year-old girl at the present department. Infect Dis (Lond). 2017 Sep;49(9):641-646.
Frank GS, Smith JM, Davies BW, Mirsky DM, Hink EM, Durairaj VD. Ophthalmic manifestations and outcomes after cavernous sinus thrombosis in children. J AAPOS. 2015 Aug;19(4):358-62. [
Caranfa JT, Yoon MK. Septic cavernous sinus thrombosis: A review. Surv Ophthalmol. 2021 Nov-Dec;66(6):1021-1030.