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KUANetal.

TABLE XIX.B.2 Evidence surrounding Tolosa–Hunt syndrome.

Clinical endpoints 1. Lesion

Study

Year LOE Study design Study groups

Conclusions

Diagnosis of THS cannot rely only on MRI findings, which should be considered in conjunction with clinical findings; in some cases, a biopsy will still be necessary 1. THS was the most frequently diagnosed type of painful ophthalmoplegia (46/77, 59.7%); however, it is essential to rule out all other causes of painful ophthalmoplegia to confirm the diagnosis of THS 2. CN III was the most commonly affected CN in THS Knowledge of the clinical presentation of THS is helpful in clinical decision-making for patients with cavernous sinus syndrome 1. THS is an agglomeration of symptoms rather than a diagnosis and may be associated with intra- and extracavernous vascular abnormalities 2. When histopathological diagnosis is unavailable, steroid-induced resolution of symptoms should be confirmed radiologically and followed up

Colnaghi et al. 973

2008 2

Systematic review

Patients with THS or orbital myositis across 48 studies ( n = 62)

location 2. Duration of

symptoms and signs

Zhang et al. 972

2014 4

Retrospective case series

Patients with

1. Clinical features 2. Radiographic findings

nontraumatic painful ophthalmoplegia ( n = 77)

Türkogˆlu et al. 974

1. Clinical features 2. Radiographic findings 1. Clinical features 2. Radiographic findings 3. False-positive THS diagnoses

2008 4

Retrospective case series

Patients with THS causing cavernous sinus syndrome ( n = 10) Cases diagnosed and managed as THS across 153 studies

Duttaand

2021

5

Scoping-type review

Anand 968

Abbreviations: MRI, magnetic resonance imaging; THS, Tolosa–Hunt syndrome.

B Lipomas Lipomas are benign tumors composed of mature fat cells. 986,987 Peak incidence is between 40 and 50 years of age with a slight male predominance. 988 Thirteen percent of lipomas occur in the head and neck and become symp tomatic due to mass effect. 989–991 Sinonasal lipomas may present with unilateral nasal obstruction, facial swelling, pain, epistaxis, and nasal discharge. Imaging shows a low-density mass on CT and high-signal intensity on T1 MRI and low to iso-intense signal on T2. 987 Histologically, lipomas resemble normal adipose tissue with a prolifer ation of mature fat cells; however, most of these tumors have chromosomal aberrations, including translocations (12q13-15), deletions (13q), and re-arrangements (8q11 13.4). 989 Due to compromised blood supply or traumatic injury, lipomas may undergo changes such as infarction, hemorrhage, cystic degeneration, and calcifications. 989,991 Curative treatment for symptomatic lesions is complete surgical excision. 987

C Pleomorphic adenoma Pleomorphic adenomas are benign mixed tumors that arise from salivary gland ductal myoepithelial and epithe lial cells. They rarely occur in the sinonasal cavity. 992,993 They present in the third to sixth decade with unilateral nasal obstruction and/or epistaxis and have a slight female predominance. 992–994 The nasal septum, lateral nasal wall, and nasopharynx are the most common primary sites; the maxillary sinus is the most commonly involved paranasal sinus. 992,994,995 CT may show an enhancing expansile lesion, and MRI typically demonstrates a well-defined lesion with low sig nal intensity on T1 MRI and variable signal intensity on T2 with heterogeneous contrast enhancement. 994,996 Pre operative tissue sampling is critical for treatment planning, particularly in tumors with aggressive behavior (skull base extension, bony invasion, PNI) or high-risk imaging fea tures (large size, poorly defined margins, T2 hypointensity) that suggest malignant potential. 992 Sinonasal pleomor-

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