This is a 59-year-old man, diagnosed with T2N2b squamous cell carcinoma of the larynx, who was initially treated with three cycles of chemotherapy without remission, so that three months later a supraglottic laryngectomy was performed, with modified incomplete radical emptying of the left side. Pathology showed an infiltrating squamous cell carcinoma in the left hemiepiglottis with 8 of 11 positive lymph nodes of the internal jugular, subdigastric and left supraclavicular chain. He subsequently received chemotherapy and radiotherapy on supraglottis and hypopharynx and bilateral lymph node areas.
Nine months after surgery, she consulted for a three-week headache associated with binocular diplopia and blurred vision in the right eye, with evidence of ophthalmoparesis of the third, fourth and sixth right cranial nerves. Magnetic resonance imaging (MRI) of the brain showed a mass in the posterior and lateral portion of the right cavernous sinus, with protrusion towards the prepontine cistern, well demarcated, with homogeneous gadolinium uptake and dimensions of 11x14.4x12.2 mm. The CT bone window showed no lytic lesions or invasion of the sphenoid wing or sinus. The thoraco-abdomino-pelvic CT scan was negative. The radiological differential diagnosis was schwannoma, meningioma or metastasis.

An open biopsy was performed with a transylvian approach to the lateral wall of the cavernous sinus where tumour invasion of the intradural space was observed. The anatomopathological result was squamous cell carcinoma. Subsequently, radiotherapy was administered as palliative treatment. Three weeks after surgery the patient consulted for dorsal pain without neurological symptoms. An MRI study of the spine showed focal lesions in the D4, D6 and D10 bodies suspicious for metastatic implants.
Radiotherapy treatment relieved the headache, but he developed ophthalmoplegia, retaining only right eye abduction. The patient died nine months after diagnosis of cavernous sinus metastasis.