PMC6031156_01
Magnetic resonance images of the brain and orbits. (a) Axial STIR T2W showed questionable mucocele of the right sphenoid sinus or sphenoidal sinusitis (white arrow) but the architecture of the optic nerve was not well defined. (b) Coronal FLAIR T2W showed right sphenoidal pathology but the right optic nerve was not well delineated.
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fig1
The previous MRI brain and orbit images were reviewed (Figure 1).
Computerized tomography of paranasal sinus. (a) Anatomical location of Onodi cell (OC); right (rt.SpS) and left sphenoid sinus (lt.SpS). (b) Open roof of superior wall of right sphenoid sinus (white arrow).
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fig2
The multidetector computed tomography (MDCT) of the paranasal sinuses illustrated a nonenhanced soft tissue density lesion in the right sphenoid sinus and no visualization of the superior wall of the right sphenoid sinus, adjacent to the right optic canal, as well as a wall that became thinner by either pressure effect of right sphenoid lesion or bony destruction (Figure 2).
Top view of Onodi cell (white dashed line) showed dehiscence of the bone over the naked right optic nerve.
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fig3
Right posterior ethmoidectomy, sphenoidotomy, and draining the content in the Onodi cell (Figure 3) were performed and found whitish bloody mucoid discharge in the Onodi cell with dehiscence of the superior wall exposing the right optic nerve.