The case presented here corresponds to a 30-year-old woman with no relevant personal history, who consulted for an initial picture of right hemicraneal headache of two months duration that progressed to hollow.
This headache had organic characteristics and was resistant to conventional treatment (non-steroidal anti-inflammatory drugs and triptans).
In addition, it was accompanied by blurred vision, more pronounced in the left eye, two episodes of self-limiting diplopia, and occasional episodes of left eyelid ptosis.
Neurological examination revealed an afferent pupillary defect in the left eye with decreased visual acuity of 0.1 and 0.25 in the right eye.
The rest of the cranial nerves showed no abnormalities on examination.
The hormonal study did not reveal any functional alteration.
Cranial computed tomography (CT) revealed a non-calcified cystic lesion that eroded the sinus as a pigment epithelium and cystic walls of the turcica.
Magnetic resonance imaging (MRI) of the brain confirmed the existence of a tumor measuring 4 x 3 x 3 cm in the sinus region. The lesion was localized, eroded and expanded the walls of the sinus.
The lesion produced compression and cranial displacement of the pituitary gland and chiasm.
It was isointense in T1-weighted sequences and hyperintense in T2-weighted sequences, with liquid-liquid levels inside, tabicated aspect and peripheral post-contrast enhancement in the sequences.
In addition, there was consolidation of the bone surrounding the cleft.
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Under general anesthesia, a sublabial transesfen approach was performed, partially resecting the lesion in its central part, with the intention of identifying optic chiasm.
Anatomopathological analysis confirmed the presence of a partially mineralized appearance tissue, with presence of irregular venous trabeculae and bronchiectasis, compatible with aneurysmal bone cyst.
In the postsurgical MRI control, an adequate compression of the chiasma with residual lesion in both lateral regions and optical coherence cells was observed.
The neuroophthalmological examination performed at three months confirms that the visual acuity of the patient was practically normal (O.D.: 1 and O.I.: 0.9).
