Anterior Clinoid Metastasis Removed Extradurally: First Case Report

Abstract

Background We report a case of isolated metastasis on the anterior clinoid process (ACP) mimicking meningioma. Clinical Presentation A 58-year-old male presented with headaches, right-sided visual disturbances, and blurred and double vision. The cause of double vision was partial weakness of the right III nerve, resulting from compression of the nerve by “hypertrophied” tumor-involved right anterior clinoid. Medical history revealed two primary malignant tumors—male breast cancer and prostate cancer (diagnosed 6 and 18 months prior, respectively). The patient was treated with chemotherapy and showed no signs of active disease, recurrence, or metastasis. Postcontrast head magnetic resonance imaging (MRI) showed extra-axial well-bordered enhancing mass measuring 1.6 × 1.1 × 1 × 1 cm (anteroposterior, transverse, and craniocaudal dimensions) on the ACP, resembling a clinoidal meningioma. Extradural clinoidectomy with tumor resection was performed via right orbitozygomatic pretemporal skull base approach. Visual symptoms improved. Follow-up MRI showed no signs of tumor residual or recurrence. Conclusion This is the first case report of a metastasis of any kind on ACP. Metastasis should be included as a part of the differential diagnosis of lesions of the anterior clinoid. Extradural clinoidectomy is a safe and effective method in the treatment of these tumors.

Anterior Clinoid Metastasis as First Presentation of a Signet Ring Cell Carcinoma: An Intriguing Diagnosis

“…In the previous case reported by Pojskić et al, the patient was under treatment with chemotherapy for a breast cancer. 12 Upon the presence of an oncological disease, the occurrence of brain metastasis at the skull base and even at the ACP could be suspected. Albeit frank evidence of a primary disease, meningioma was suspected among the possible differential diagnosis.…”

“…[24][25][26][27][28][29][30][31][32] With the suspicious of a malignant tumor pathology, one more argument favoring the extradural clinoidectomy is to minimize the possibility of intradural tumor spread. 12 Nonetheless, the long-standing history of the severe visual impairment can explain the lack of any postoperative improvement.…”