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

Abstract

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.

Keywords: Anterior clinoid process; Mucocele; Optic neuropathy.

Fig. 1

Preoperative CT axial cuts at the level of the orbit and skull base, a. bone window display, and b. soft tissue window display, showing the expanding mucocele as soft tissue density, with thinning out of remodeled left ACL (arrow in a, and b).

Fig. 2

a. Coronal T1, b. Coronal T2, and c. Axial T1-Fat saturated post-I.V. gadolinium contrast medium injection: Preoperative MRI of brain and skull base, showing the mucocele in ACP appearing as an expansile lesion of bright signal on T1, low signal on T2, and peripheral marginal enhancement on post-I.V. contrast images (thick arrow in a, b, and c respectively), and the compressed left optic nerve canal medial to ACP (thin arrow in a.).

Fig. 3

Post-operative MRI, a. axial T1, and b axial T1 fat saturated post-I.V. gadolinium contrast, showing excised mucocele, with fat packing suppressed on fat saturated images, with no abnormal enhancement (arrow in a, and b).