Cavernous sinus syndrome as the first manifestation of metastatic breast disease

The cavernous sinus is a venous plexus crossed by vital neurovascular structures. Metastases to the region are uncommon and often associated with a headache, facial pain, or progressive neurological deficit in III, IV, and VI cranial nerves. The treatment options are surgery, including endoscopic approach, radiotherapy, radiosurgery, and chemotherapy.

We report the case of a 26-year-old female with cavernous sinus syndrome due to breast cancer metastasis, who was subjected to chemotherapy with complete neurological recovery. A literature review was performed using the databases Bireme, Pubmed, Cochrane, Lilacs and Medline with the keywords: cavernous sinus/metastasis/surgery/radiosurgery for multiple management options review.

Cavernous sinus metastases are rare, and the cavernous sinus syndrome is rarely the first sign of cancer, especially in young patients. Because the syndrome has multiple causes, the history of rapid progression and atypical image findings can arise suggesting metastatic diseases. As in our case, the image was suggestive of meningioma, however, the clinical presentation and further investigations led us to suspect as a metastatic disease. The therapeutic decision considers clinical and functional status, the extent of primary and metastatic disease, radiological study, tumor histopathology, and biological behavior. Often associated with significant symptoms and disseminated systemic disease, nowadays radiosurgery is the first and less invasive strategy, offering low risk of new deficits, clinical improvement, and good local control. The prognosis depends on early treatment and disease staging because mortality is associated with progression of cancer.