Unilateral Ophthalmoplegia Secondary to Anterior Clinoid Process Mucocele

Abstract

A 50-year-old Chinese man presented with rapidly progressive unilateral ophthalmoplegia and then an ipsilateral afferent pupil defect. CT and MRI revealed a mass centered in the anterior clinoid process causing bone destruction and showing high T1 and T2 signal intensity indicative of mucosal protein secretion. These imaging features suggested a mucocele, which may have resulted from sequestration of a clinoidal extension of the sphenoid sinus. The sphenoid sinus was opened via an image-guided endoscopic approach, and the lesion incised. There were no complications. The ophthalmoplegia and afferent pupil defect had completely resolved within 1 week of surgery. This is the eighth reported case of anterior clinoidal mucocele, a rare cause of ophthalmoplegia or optic neuropathy. Advances in endoscopic instrumentation, navigation systems, and intraoperative imaging have reduced the operative risk and made the endoscopic approach a feasible and safer alternative to open surgery for this condition.

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

“…Because of their compressive nature, most authors advocate early surgical decompression of the cystic lesion via an endoscopic transnasal approach [11,12,14,15,18,19,22] or a transcranial approach [4,9,10,13,16,17]. A large marsupialization of the mucocele is generally definitive and complete removal of the cyst wall should be performed whenever possible [23].…”

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

“…11 The formation of an anterior clinoid process mucocele is considered to occur secondary to closure of the passage from the paranasal sinus that aerates the pneumatised anterior clinoid process. 1,2,7,9 Because expansion of the mucocele may cause severe visual impairment, prompt surgical treatment is recommended. 7,9,10 In the present case, steroid pulse therapy was effective in two previous ocular episodes.…”

“…Surgical treatment should be considered for a better visual prognosis because of reduction of the operative risk with advances in surgical techniques and instruments. 2 We reviewed the literature of anterior clinoid process mucoceles causing visual dysfunction or oculomotor deficits (Table 1). Among all identified cases, only two involved nonsurgical treatment.…”

“…8,9 Because this condition may have a poor prognosis, 3,4,6 urgent surgical treatment including craniotomy or endoscopic drainage has been proposed. 2,5,7,9,10 The long-term course of this disease without surgical treatment has not been well described, especially when alternative treatment resulted in improvement and remission for several years. We herein present a case involving a patient with optic neuropathy due to mucocele formation in a pneumatised anterior clinoid process treated with steroid pulse therapy.…”

“…1,2 Expansion of the mucocele may cause headache, vision loss, visual field deficits, ophthalmoplegia, diplopia, ptosis, or color blindness secondary to multiple cranial nerve paralysis. [2][3][4][5][6][7] The optic nerve is most commonly affected, 7 resulting in visual impairment due to compression or inflammation of the nerve. 8,9 Because this condition may have a poor prognosis, 3,4,6 urgent surgical treatment including craniotomy or endoscopic drainage has been proposed.…”