Which Classification of Cavernous Sinus Syndrome is Better - Ishikawa or Jefferson? A Prospective Study of 73 Patients.
BACKGROUND
Ishikawa and Jefferson are the two most commonly used systems used for the classification of cavernous sinus syndrome (CSS). However, relative utilities of these two classification systems have not been evaluated in detail in developing countries. In this study, we compared relative utilities of these two classification schemes in the evaluation of CSS.


OBJECTIVE
To compare the utility of Jefferson and Ishikawa classifications in the evaluation of CSS.


METHODS
A total of 73 consecutive patients of CSS were prospectively classified using either Ishikawa or Jefferson classification and relative utility of these two classification schemes in determining etiology of CSS was compared.


RESULTS
While only 46.6% of patients could be classified using Jefferson classification, 95.5% of patients could be classified using Ishikawa scheme. CSS was classified as anterior, middle, and posterior in 17.8%, 21.9%, and 8.2% of patients, respectively, as per the Jefferson classification. As per the Ishikawa classification, 37% of patients each showed anterior and posterior CSS, 16.4% showed middle CSS, whereas 4.1% had whole CSS. Middle CSS was significantly associated with the presence of fungal infections (P= 0.045) as per Jefferson classifications, and anterior CSS was significantly associated with a vascular etiology (P= 0.005) as per Ishikawa classification. Overall, inflammatory causes were the most common cause for anterior CSS, while tumors accounted for maximum cases of posterior CSS.


CONCLUSIONS
Although more number of patients could be classified using Ishikawa classification, there was no advantage of Ishikawa classification over Jefferson with regard to determination of etiology of CSS.
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Sanat
S
Bhatkar
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Manoj Kumar
MK
Goyal
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Aastha
A
Takkar
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Manish
M
Modi
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Kanchan K
KK
Mukherjee
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Paramjeet
P
Singh
Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Bishan Das
BD
Radotra
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Ramandeep
R
Singh
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Vivek
V
Lal
Cavernous sinus syndrome; Ishikawa; Jefferson