Unilateral ophthalmoplegia secondary to anterior clinoid process mucocele

A Rare Case and Literature Review of Endoscopic Endonasal

We report a rare case of localized anterior clinoid mucocele (ACM) with acute visual loss and a literature review of the endoscopic endonasal surgery. We advocate that endoscopic endonasal approach is the best choice. To our knowledge there a limited report on localized ACM that treated via endoscopic endonasal approach.

Anterior clinoid mucocoele presenting as progressive fluctuating visual loss mimicking inflammatory optic neuropathy

Optic nerve lesions usually produce monocular visual loss, and in compressive optic neuropathies, gradual vision loss is the more usual presentation. Mucocele in the anterior clinoid process is a rare cause of compressive optic neuropathy that can lead to monocular visual loss. A 19-year-old Sri Lankan girl presented with progressive, painless fluctuating right-sided monocular visual loss over 1-year duration. On presentation, right side visual acuity was 6/60 and fundoscopy revealed pale disk on the right side. Ocular tomography showed right-sided temporal retinal thinning. Magnetic resonance imaging revealed right anterior clinoid process mucocele causing compression and kinking of the right optic nerve. Because the right side, optic disc was already pale and retina was thinned, we decided to manage conservatively. Early imaging in compressive optic neuropathy is useful for the diagnosis and early neurosurgical intervention. Delaying the diagnosis can lead to permanent visual loss.

Anterior Clinoid Metastasis Removed Extradurally: First Case Report

Background  We report a case of isolated metastasis on the anterior clinoid process (ACP) mimicking meningioma.

Clinical Presentation  A 58-year-old male presented with headaches, right-sided visual disturbances, and blurred and double vision. The cause of double vision was partial weakness of the right III nerve, resulting from compression of the nerve by “hypertrophied” tumor-involved right anterior clinoid. Medical history revealed two primary malignant tumors—male breast cancer and prostate cancer (diagnosed 6 and 18 months prior, respectively). The patient was treated with chemotherapy and showed no signs of active disease, recurrence, or metastasis. Postcontrast head magnetic resonance imaging (MRI) showed extra-axial well-bordered enhancing mass measuring 1.6 × 1.1 × 1 × 1 cm (anteroposterior, transverse, and craniocaudal dimensions) on the ACP, resembling a clinoidal meningioma. Extradural clinoidectomy with tumor resection was performed via right orbitozygomatic pretemporal skull base approach. Visual symptoms improved. Follow-up MRI showed no signs of tumor residual or recurrence.

Conclusion  This is the first case report of a metastasis of any kind on ACP. Metastasis should be included as a part of the differential diagnosis of lesions of the anterior clinoid. Extradural clinoidectomy is a safe and effective method in the treatment of these tumors.

Anterior clinoid mucocele causing optic neuropathy: A case report and review of literature

A 66 year old Indian gentleman presented with a 3 days history of headache and gradual progressive loss of vision in his eft eye, ophthalmological assessment showed no light perception in his left eye with papilledema and afferent papillary defect. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) were done and showed an expanding lesion in the left anterior clinoid process encroaching upon the left orbital apex and optic nerve with features suggestive of a mucocele. Patient was started on dexamethasone, and urgent craniotomy was undertaken, where marsupialization and resection of left anterior clinoid mucocele was done, and histopathologic examination of the operative specimen was consistent with a mucocele. Post-operatively, patient was kept on dexamethasone for few days, with uneventful outcome, and his follow up at 6 months showed complete recovery of his vision from no light perception to 6/12 in the affected eye.

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Anterior clinoid mucocele should be considered as one the differential diagnosis for optic neuropathy.

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CT/MRI should be done as part of workup in patients presenting with acute onset optic neuropathy.

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Surgical decompression is recommended over medical management with antibiotics and/or steroids.

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The timely radiological diagnosis and immediate surgical decompression was crucial to achieve for full recovery of vision.

Spheniodal mucocele causing bilateral optic neuropathy and ophthalmoplegia

Sphenoid sinus mucocele comprises only 2% of all paranasal sinus mucoceles. In literature, there is a case report on sphenoidal mucocele causing bilateral optic neuropathy, with unilateral partial recovery and cranial nerve palsy, but we did not come across any literature with bilateral optic neuropathy and ophthalmoplegia together caused by spheno-ethmoidal mucocele. We present such a rare case of spheno-ethmoidal mucocele causing bilateral optic neuropathy and unilateral sixth nerve palsy who had postsurgery, unilateral good vision recovery, and complete resolution of sixth nerve palsy.

Recurrent Optic Neuropathy Caused by a Mucocele of the Anterior Clinoid Process after a 5-Year Remission: A Case Report and Literature Review

A 32-year-old male presented with acute left vision loss during a second recurrence of optic neuropathy. Steroid pulse therapy had been effective in both the first episode 9 years previously and the first recurrence 5 years previously. Magnetic resonance imaging demonstrated an anterior clinoid process mucocele compressing the optic nerve. Although surgical treatment was performed, improvement was limited. This report indicates that steroid pulse therapy could be an alternative treatment to obtain temporary remission, but surgical treatment should be considered to prevent irreversible neurological deficits. This paper also presents a review of the literature on anterior clinoid process mucoceles.

Anterior clinoid mucocele presenting with orbital apex syndrome

Background:

Pneumatized anterior clinoid process is a common anatomic variant. Mucocele formation is a known complication of clinoid drilling during certain intracranial operations; however, mucoceles of pneumatized anterior clinoid processes have been found to spontaneously occur.

Case Description:

A 44-year-old male presented with complaints of left-sided retro-orbital pain, double vision, and numbness over the upper face and scalp on the left side of 1-week duration. On examination, he was found to develop cranial nerve III, IV, and VI palsies with pupillary sparing, ophthalmic division cranial nerve V dysfunction, and eventually, the onset of vision loss.

Conclusions:

We report a case of spontaneous anterior clinoid process mucocele presenting with orbital apex syndrome. This was treated successfully with anterior clinoidectomy for decompression.

Complete recovery of acute monocular visual loss following endoscopic resection of anterior clinoid mucocele: case report and review of the literature

Mucoceles are chronic non-neoplastic cystic lesions lined by mucus-secreting respiratory epithelium in the paranasal sinuses. Mucocele of the anterior clinoid process is a particularly rare entity most often presenting with rapidly progressive monocular blindness. The authors describe the case of a 32 year-old man who presented with acute painless visual loss in the left eye. Workup revealed an expansile lesion of the left anterior clinoid process with associated optic nerve compression. The patient underwent emergent endoscopic-assisted transnasal decompression of the optic nerve with full recovery of visual function. Early diagnosis and prompt surgical intervention optimizes the chances of functional regain of visual acuity.