Presentation
History of osteogenesis imperfecta, ruptured left ICA aneurysm s/p clipping, and hydrocephalus s/p right-sided VP shunt who presented with pressure and bulging of the left eye. On exam, patient exhibited proptosis and downward displacement of the left eye.
Patient Data
Air-fluid level within the left sphenoid sinus. Proptosis and downward displacement of the left globe secondary to mass effect from left frontal sinus mass. Similar-appearing bony dehiscence involving the bone covering the left sided mucocele lateral margin.
There are small areas of encephalomalacia and gliosis in involving bilateral superior frontal gyrus anteriorly, likely related to previous old infarctions. Also changed small area of encephalomalacia and gliosis left caudate nucleus. The postsurgical changes consistent with prior left frontal temporal craniotomy and left pterional craniotomy. There is a right occipital approach shunt catheter with the tip terminating within the right lateral ventricle abutting the septum pellucidum. Left suprasellar cistern aneurysm clip is seen.
Case Discussion
This is a case of a mucocele. Unfortunately, the aneurysm clip from a previously ruptured left internal carotid artery aneurysm was not MRI compatible so no MRI images could be obtained.
The patient underwent reopening of previous left craniotomy, evacuation of mucocele and left frontal cranioplasty. Gross pathological examination revealed a 2.7 x 2.5 x 0.5 cm mass of tan-pink irregular portions of fibromembranous tissue. Histopathology demonstrated benign sinonasal mucosa, submucosa, and bone with mucocele formation. There was chronic inflammation, submucosal acute inflammation, granulation tissue, fibrosis, and remodeling of bone.
She was discharged on a two-week course of levofloxacin and did well post-operatively. At two-week, 1- and 3- month follow up, she was noted to have significant improvement in proptosis (resolved) and vision without pain or pressure symptoms. Subsequent imaging has not shown recurrence of the mucocele.
Co-author:
Luciano Venturino
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