Prognosis

The overall mortality rate associated with septic cavernous sinus thrombosis (CST) has decreased from 80% to 100% in the pre-antibiotic era to 20% to 30% since 1940.[1]

Once the acute phase has resolved, recovery is gradual. Up to 30% have serious sequelae, including:[10][15]​​[22]​​[50][92]

  • Residual cranial nerve (CN) paresis, affecting CN III and CN IV predominantly

  • Blindness

  • Hemi-paresis

  • Dysphasia

  • Pituitary insufficiency

  • Residual facial swelling and discoloration.

Morbidity and mortality are especially high when diagnosis and treatment are delayed.[15] Early management of the primary source of infection, such as endoscopic sinus surgery for sphenoid sinusitis, is crucial in reducing morbidity and mortality.[13] There are limited data distinguishing outcomes in septic versus aseptic CST, although, generally, it is thought that outcomes are better in aseptic disease.

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