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

Abstract

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.

Keywords: Anterior clinoid process; craniotomy; high-dose methylprednisolone; mucocele; optic neuropathy.

FIGURE 1

(A) T2-weighted MR image (left panel: axial image) and gadolinium-enhanced T1-weighted MR image (middle and right panels: parasagittal image and coronal image, respectively) of the brain at the first visit. A cystic lesion of high signal intensity without contrast enhancement on T1- and T2-weighted images was present in the left optic canal, compressing the optic nerve (white arrows). (B) T2-weighted MR image (left panel: coronal image) and gadolinium-enhanced T1-weighted MR image (middle and right panels: parasagittal image and coronal image, respectively) at the first recurrence 5 years previously. T2-weighted (left panel) and parasagittal T1-weighted (middle panel) images show a cystic lesion compressing the optic nerve (white arrows). Arrowheads in the middle panel indicate a slight enhancement effect in the optic nerve sheath. The enhancement is also observed in the coronal section (right panel, arrowhead) taken at the level indicated by the arrowheads in the middle panel.

FIGURE 2

Visual field of the left eye plotted with Goldmann perimetry (A) after steroid pulse therapy and (B) after mucocele resection. The improvement was limited. The results of the first recurrence 5 years previously are displayed in (C) (before steroid pulse therapy) and (D) (after steroid pulse therapy). The visual filed remarkably improved with steroid pulse therapy. The painted-out and hatched regions indicate an absolute and a relative scotoma, respectively.