Abstract
BACKGROUND: Intraosseous lipomas are rare developmental anomalies that present with visual impairment. Due to their infrequency, they often pose diagnostic challenges, particularly in differentiating them from more common optic nerve pathologies. Magnetic resonance imaging (MRI) plays a crucial role in the early identification and management of these lesions. CASE SUMMARY: We present the case of a 41-year-old male with a history of dyslipidemia who developed sudden onset headaches and decreased vision in his left eye. MRI revealed a T1-hyperintense fat-containing lesion within the left anterior clinoid process of the sphenoid bone at the optic canal, causing extrinsic compression of the left optic nerve, initially interpreted as a lipoma. Intraoperatively, the previously thought lipoma lesion was actually shown to be adipose tumor of the bone and pathological examination confirmed the diagnosis. The left optic nerve was successfully decompressed, and the patient's vision improved significantly post-op. This case highlights that while MRI is essential in evaluating optic nerve compressive lesions, radiologic findings alone may be insufficient, and surgical and pathological correlation remains crucial for accurate diagnosis. CONCLUSION: This case highlights the importance of considering intraosseous lipoma of the sphenoid bone as a rare cause of optic nerve compression and emphasizes the pivotal, but not definitive, role of MRI, which must be complemented by surgical and histopathological correlation to prevent irreversible visual loss.