Recovery of Visual Function in a Patient with an Onodi Cell Mucocele Compressive Optic Neuropathy Who Had a 5-Week Interval between Onset and Surgical Intervention: A Case Report

Abstract

Purpose. To report on a patient with compressive optic neuropathy secondary to an Onodi cell mucocele, who fully recovered visual function following surgery. Method. Case report. Results. A 28-year-old male was admitted with a right visual acuity of 20/100 following treatment for an initial diagnosis of optic neuritis. Subsequent examination suggested compressive optic neuropathy, and neuroimaging confirmed the presence of an Onodi mucocele compressing the optic nerve. The patient underwent a right endonasal sphenoethmoidectomy with decompression 5 weeks after the initial onset of symptoms. Three weeks following surgery, the visual acuity was 20/20, and there was complete resolution of the visual field defect, which has remained stable at 1 year. Conclusion. Onodi cell mucocele should be included in the differential diagnosis of a young patient with compressive optic neuropathy. Surgical decompression should be considered even when symptoms have been present for over a month.

Visual loss in patients with sphenoethmoidal cells

“…[11][12][13][14][15][16][17][18] This can present with sudden, or occasionally gradual, unilateral loss of vision, often with associated pain. Mucoceles are the most commonly reported cause of optic neuropathy.…”

“…Mucoceles are the most commonly reported cause of optic neuropathy. 16 Infection involving a sphenoethmoidal cell without mucocele formation has also been implicated as a cause of optic neuropathy and orbital apex syndrome. In one reported case, the visual loss was bilateral because the large sphenoethmoidal cell extended laterally around both optic nerves.…”

Optıc Neuropathy Secondary to Inflammation of Sphenoidal Sinuses and Onodi Cell Polyps: A Case Report

“…1,2 It is an anatomical variant of the posterior ethmoidal cells that surround the optic nerve and is ventilated by the sphenoid sinuses. 2,3 When the migration of the posterior ethmoidal cells is completed, the Onodi cell occurs around the optic nerve. 2 In the literature, the incidence of an Onodi cell is from 8 to 13% in radiological findings but the rate is 60% in cadaveric studies.…”

“…2 In the literature, the incidence of an Onodi cell is from 8 to 13% in radiological findings but the rate is 60% in cadaveric studies. 3 Many cases of sphenoethmoidal mucoceles with visual disturbances have been reported. However, pathology of an Onodi cell is rare 1 ; case reports are more prevalent in the Far East than in Western countries.…”

“…If the thickness of the slices is greater than the width of the Onodi cell, variations cannot be differentiated. 3 MRI scans are also required to determine the protein content of the Onodi cell material and to differentiate the nature of the lesion, 3 including mucocele, pyocele, and tumor. 1 Onodi cell infections frequently cause acute visual loss that can be reversed with early treatment.…”