Anterior clinoid mucocele presenting with orbital apex syndrome

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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.

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Most cited references 27

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Risky anatomic variations of sphenoid sinus for surgery.

Funda Batay, Gülsah Bademci, Birsen Unal Daphan … (2006)

We searched for the surgically risky anatomic variations of sphenoid sinus and aimed to compare axial and coronal tomography in detection of these variations. Fifty-six paranasal tomography images (112 sides) were evaluated for coronal, axial and both coronal and axial images. Tomographic findings including bony septum extending to optic canal or internal carotid artery; protrusions and dehiscences of the walls of internal carotid artery, optic nerve, maxillary nerve and vidian nerve; extreme medial course of internal carotid artery; patterns of aeration of the anterior clinoid process; and Onodi cells were evaluated. The results were classified as "present, absent, suspicious-thin (only for dehiscence) or no-consensus". The results of each plane were compared with that of the result of the both planes together. Kappa coefficient and Chi-square tests were used to compare both planes. Twelve cadaveric dissections were performed to reveal the proximity of sphenoid sinus to surgically risky anatomic structures. Endoscopy was applied to five cadavers. 18 evaluations were classified as 'no-consensus'. We detected 34, 35, 34 and 40 protrusions of internal carotid artery, optic nerve, maxillary nerve, vidian nerve, respectively. Dehiscences were present in 6, 9, 4 and 8, and suspicious-thin in 8, 10, 16 and 25 in canals of internal carotid artery, optic nerve, maxillary nerve and vidian nerve, respectively. Bony septum to internal carotid artery and optic nerve was observed in 30 and 22 cases. We observed 9 extreme medial courses of internal carotid artery, 27 aerated clinoid process and 9 Onodi cells. Axial images were superior in detection of bony septum to internal carotid artery and Onodi cells; while the coronal images were more successful in detection of protrusion of optic nerve and vidian nerve, and dehiscense of maxillary nerve and vidian nerve (P<0.05). In cadaveric dissections, the septa were inserted into the bony covering of the carotid arteries in two sinuses (8.3%). Detailed preoperative analysis of the anatomy of the sphenoid sinus and its boundaries is crucial in facilitating entry to the pituitary fossa and reducing intraoperative complications. Coronal tomography more successfully detects the sphenoid sinus anatomic variations.

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Evaluation of some important anatomical variations and dangerous areas of the paranasal sinuses by CT for safer endonasal surgery.

S. Basak, C Z Karaman, A Akdilli … (1998)

The purpose of this study is to determine some important variations and dangerous areas carrying risks for major complications, in the routine CT examination. We also made specific measurements to evaluate the individual differences. This prospective study consisted of 111 patients (222 sides). Eighty patients underwent coronal, and the rest coronal and axial CT. The depth of lamina cribrosa, its distance to the inferior turbinate, and the distance of anterior ethmoidal artery (AEA) either to the orbital roof or inferior turbinate were measured. Variations of the upper attachment of uncinate process were encountered in 23%. AEA coursed freely within ethmoidal cells in 43%. Anterior clinoid aeration was seen in 14%, optic canal bulging into the sphenoid sinus in 13% and an extreme medial course of the carotid canal in 12% of the patients. The mean depth of lamina cribrosa was 5.9 mm, and its mean distance to the inferior turbinate was 25.7 mm. The mean distance of AEA to the orbital roof was 13.7 mm, and to the inferior turbinate 30.05 mm. Anterior clinoid aeration correlated well with the variations of carotid and optic canals, statistically (p < 0.01). A detailed CT study will provide important information on the areas carrying risks of complications and the size of the area to be worked on.

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Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery.

M. BOZKURT, A Aydinlioğlu, E Egeli … (1998)

Chronic rhinosinusitis endoscopic surgery requires an accurate evaluation of diseases and paranasal sinus anatomic variations. This study aims to show the main anatomical variations in the ostiomeatal complex and paranasal sinuses which are usually depicted by computed tomography (CT). CT scans obtained 2 mm thickness in axial and coronal plane from a series of 200 patients with chronic sinusitis were examined to determine the prevalence of anatomic variants. Anatomical variations determined were supraorbital recess in 6%, concha bullosa in 30%, sphenomaxillary plate in 17%, infra-orbital ethmoid cells (Haller's cells) in 6%, spheno-ethmoid cells (Onodi's cells) in 12%, pneumatization of the anterior clinoid process in 6%, carotid artery bulging into the sphenoid sinus in 8%, pneumatization of the uncinate process in 2%, paradoxical curvature of the middle turbinate in 3% and septal deviation in 36%. Level difference between the ethmoid roof and nasal vault was an average of 8 mm in right side and 9.5 mm in left side. Awareness of these different variations will help the rhinologic surgeon in his orientation during endoscopic surgical procedures.

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Author and article information

Journal

Journal ID (nlm-ta): Surg Neurol Int

Journal ID (iso-abbrev): Surg Neurol Int

Journal ID (publisher-id): SNI

Title: Surgical Neurology International

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2229-5097

ISSN (Electronic): 2152-7806

Publication date Collection: 2013

Publication date (Electronic): 09 May 2013

Volume: 4

Electronic Location Identifier: 63

Affiliations

[1]Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA

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[* ]Corresponding author

Article

Publisher ID: SNI-4-63

DOI: 10.4103/2152-7806.111583

PMC ID: 3680997

PubMed ID: 23772333

SO-VID: a0b9f24b-d3d5-4886-a305-05c0ebf64ba8

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Anterior clinoid mucocele presenting with orbital apex syndrome

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Abstract

Background:

Case Description:

Conclusions:

Related collections

ScienceOpen Clinical Case Reports Collection

Most cited references 27

Risky anatomic variations of sphenoid sinus for surgery.

Evaluation of some important anatomical variations and dangerous areas of the paranasal sinuses by CT for safer endonasal surgery.

Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery.

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