PMC5778558_01
Photograph of the patient. (a) Neurofibromas. (b) Proptosed right eye. (c) Lisch nodule. (d) Cafe-au-lait spots
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F1
Anterior segment examination revealed multiple Lisch nodules on iris [Fig. 1].
(a) Skull anteroposterior radiograph showing the absence of right innominate line (red arrow). (b) Axial computed tomography in bone window confirming the absence of right-side innominate line. (c) Axial T1-weighted image demonstrating right-sided proptosis with herniation of temporal lobe
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F2
MRI revealed expansion and (antero-posterior) enlargement of middle cranial fossa with herniation of right temporal lobe with dura into posterior aspect of the right orbit causing compression and medial displacement of right optic nerve [Fig. 2].
Surgical findings. (a) Intracranial dissection exposing orbital defect. (b) Dura excised exposing herniated enlarged temporal lobe with intact arachnoid
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F3
Bone flap was replaced and wound closed [Fig. 3].
Axial computed tomography scan images in the bone window (a) preoperative computed tomography shows right eye proptosis with heniation of temporal lobe compressing optic nerve. (b) Immediate postoperative computed tomography showing reduced herniation with polymethyl methacrylate graft in situ with soft-tissue edema
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F4
Repeat CT scan revealed bone graft in situ in the right sphenoid region [Fig. 4].