Anterior clinoid mucocele and mono-ocular vision loss – Rare case with diagnostic dilemma

We report a case of a 58-year-old gentleman who presented with a 5-month history of headache and gradual progressive loss of vision in his left eye; ophthalmological assessment showed only light perception in his left eye with a relative afferent pupillary defect. Magnetic Resonance Imaging (MRI) revealed left parasellar region compressing and displacing the optic nerve medially. The lesion was hyperintense on Fat-saturated T1-weighted image (WI), T2-WI and time-of-flight MR angiography sequence raising the possibility of aneurysm. Computed tomography (CT) showed single, thin-walled expansible lesion at anterior clinoid process compromising left optic canal and orbital apex. Contrast-enhanced CT angiography didn't show any evidence of aneurysm.Anterior clinoid mucocele was kept as provisional diagnosis and patient was referred to our department. The mucocele was removed by trans nasal trans-sphenoidal approach and navigation system was used to locate the site of lesion.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research