Abstract
Background:Pneumatized anterior clinoid process is a common anatomic variant. Mucocele formation is a known complication of clinoid drilling during certain intracranial operations; however, mucoceles of pneumatized anterior clinoid processes have been found to spontaneously occur.Case Description:A 44-year-old male presented with complaints of left-sided retro-orbital pain, double vision, and numbness over the upper face and scalp on the left side of 1-week duration. On examination, he was found to develop cranial nerve III, IV, and VI palsies with pupillary sparing, ophthalmic division cranial nerve V dysfunction, and eventually, the onset of vision loss.Conclusions:We report a case of spontaneous anterior clinoid process mucocele presenting with orbital apex syndrome. This was treated successfully with anterior clinoidectomy for decompression.
Highlights
Pneumatized anterior clinoid process is a common anatomic variant
Pneumatized anterior clinoid process (ACP) is a common incidental finding seen on cross‐sectional imaging and intraoperatively
Mucocele formation is a known complication of clinoid drilling during certain intracranial operations, and care must be taken to prevent this occurrence by sealing off any exposure to a pneumatized ACP when encountered
Summary
We report a case of spontaneous anterior clinoid process mucocele presenting with orbital apex syndrome. Within 2 days, his neurologic examination progressed such that he demonstrated complete paralysis of abduction, adduction, and infraduction, with incomplete paralysis of supraduction and further ptosis of the left eye. He developed resting esotropia, infratropia, and anisocoria, and his left pupil became sluggish and less‐reactive to light. Histopathologic evaluation confirmed a mucocele, showing the presence of ciliated epithelium and dense connective tissue with extensive lymphocytic infiltration Following resection of this ACP mucocele, the patient noted almost immediate improvement of vision in his left eye. While he had some relapse of ptosis of the left eye, his vision remained stable following decompression, and he has had no recurrence in over 2 years
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