Anterior clinoidal mucocele causing optic neuropathy: resolution with nonsurgical therapy

Abstract

The rare occurrence of an inflammatory mucocele in a pneumatized anterior clinoid process is described. The patient, a 20-year-old woman, presented with a severe visual field defect in her right eye associated with abnormality in the right anterior clinoid process identified on computed tomography and magnetic resonance imaging. Initially, surgical intervention was recommended for resection of a possible neoplasm. The patient's clinical history, however, was significant for sinusitis accompanied by sore throat and right ear infection that resolved with oral antibiotic therapy. When her condition was evaluated approximately 1 month after the onset of her visual symptoms, the patient had regained full visual acuity in the affected eye. Surgical exploration was not required, and the patient's optic neuropathy reversed with appropriate antibiotic therapy.

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

“…Onodi cells are therefore similar to pneumatized anterior clinoid processes in their proximity to the optic nerve and canal, however they are anatomically distinct. Mucoceles involving the anterior clinoid process are particularly rare with only 16 other cases reported in the literature (Table 1) [4][5][6][9][10][11][12][13][14][15][16][17][18][19].…”

“…Patients with mucoceles involving the anterior clinoid process mainly present with orbital symptoms including ipsilateral retroorbital pain and progressive monocular visual loss [4][5][6][9][10][11][12][13][14][15][16][17][18]. The visual disturbance can fluctuate over time and range from complete blindness to a limited visual field defect such as a central scotoma [20].…”

“…These cystic lesions can enlarge over time leading to erosion and remodeling of bone with compression of adjacent structures. Because of their proximity to the optic canal and superior orbital fissure, mucoceles of the anterior clinoid process often cause optic neuropathy, as well as dysfunction of the third, fourth, fifth, or sixth cranial nerves [4][5][6].…”

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

“…3,8 In another case, a patient with severe sinusitis and ear infection presented with visual field loss and received oral antibiotics, resulting in full visual recovery. 8 Because our patient did not have sinusitis or any symptoms of infection, antibiotics were not considered. Cystic lesions may mimic neoplasms such as meningiomas or schwannomas, which should be considered as differential diagnoses.…”

“…[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. 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.…”