Cholesteatoma of the sphenoid sinus presenting as painful optic neuropathy

Abstract

The authors examined a 45-year-old-woman complaining of a dull pain located in the left retro-orbital area, which had started six months previously. She also reported a progressive blurring of vision in the left eye that had developed over the last two months. She had a history of chronic sinusitis beginning in her twenties. Two years prior to the examinaton she had sustained a minor head injury. Skull X-rays performed at that time showed a mass lesion in the sphenoid sinus, which however was overlooked. The authors found that visual acuity was 20/20 in both eyes and that, with Goldmann kinetic perimetry, the blind spot was enlarged and isopters were moderately constricted in the left eye. CT scan and MRI showed a large homogeneous non-enhancing lesion within the left sphenoid sinus, compressing the left optic nerve. At surgery, an encapsulated cyst was found containing a yellowish material. Histological examination led to a diagnosis of cholesteatoma. To the authors′ knowledge, this is the first description of a cholesteatoma of the sphenoid sinus resulting in compression of the optic nerve. This observation illustrates the difficulty of early diagnosis of such lesions, which can progress over the years before altering the function of neighboring nervous structures.

Key Words:

• Cholesteatoma
• sphenoid sinus
• optic neuropathy