Unilateral ophthalmoplegia secondary to anterior clinoid process mucocele.
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.
Forer
Boaz
B
Department of Otolaryngology Head and Neck Surgery, Singapore General Hospital, Singapore. boazforer@gmail.com
Hui
Ng Yuk
NY
Sethi
Dharmbir Singh
DS
D006801:Humans; D008297:Male; D008875:Middle Aged; D009078:Mucocele / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000209:etiology*; D010254:Paranasal Sinus Diseases / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D011859:Radiography; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery