Clivus pathologies from diagnosis to surgical multidisciplinary treatment. Review of the literature

Pagella, Fabio; Ugolini, Sara; Zoia, Cesare; Matti, Elina; Carena, Paolo; Lizzio, Roberta; Benazzo, Marco

doi:10.14639/0392-100x-suppl.1-41-2021-04

Cited by 7 publications

(10 citation statements)

References 41 publications

(44 reference statements)

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“…Surgical approaches have previously relied on microsurgical transcranial techniques from the anterior, posterior, and lateral directions; however, endoscopic transnasal transclival approaches are becoming increasingly favored. 8 The management of symptomatic craniofacial fibrous dysplasia is not established but decompressive surgery if often considered. A comprehensive meta-analysis of 241 patients with fibrous dysplasia with 86 clinically impaired optic nerves confirmed a postsurgical improvement in visual function in around two-thirds but a statistically significant postoperative visual deterioration for asymptomatic nerves.…”

Section: Discussionmentioning

confidence: 99%

Pearls & Oy-sters: Sequential Bilateral Hearing and Vision Loss With Optic Disc Swelling Due to Sphenoid Bone Craniofacial Fibrous Dysplasia

2023

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Bilateral optic disc swelling is a common finding but rarely associated with multiple cranial neuropathies. In this case, an 18-year-old male presented with subacute sequential hearing loss followed by subacute sequential visual loss. Clinical examination revealed bilateral optic disc swelling. Lumbar puncture revealed a normal opening pressure of 15 cmH2o. This case discusses a rare but important cause of bilateral optic disc swelling in the context of hearing loss, disequilibrium and a normal CSF opening pressure. An overview of the literature is provided and treatment options are discussed to guide further management of similar cases.s

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Section: Discussionmentioning

confidence: 99%

Pearls & Oy-sters: Sequential Bilateral Hearing and Vision Loss With Optic Disc Swelling Due to Sphenoid Bone Craniofacial Fibrous Dysplasia

2023

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“…Metastatic tumors involving the clivus are estimated to account for less than 0.02% of all intracranial tumors 5 . Though chordomas comprise the majority of clival tumors, clival masses in patients with a known cancer diagnosis are nevertheless more likely to be of metastatic origin 6,7 . A recent meta-analysis by Jozsa et al showed that, by incidence, metastatic tumors to the clivus most frequently arose from prostate, kidney, and lung primaries 5 .…”

Section: Discussionmentioning

confidence: 99%

“…T1-weighted images with heterogeneous contrast enhancement 1 . Notably, metastatic lesions may be hypointense on T2-weighted images 7 , thus providing a potential differentiating factor from T2-hyperintense chordomas and chondrosarcomas. Although MRI may help differentiate between various clival tumors preoperatively, it is rarely definitive, particularly when heterogeneous entities like metastatic disease are suspected 18 .…”

Section: Manuscriptmentioning

confidence: 99%

Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example

Baier,

Cheong,

Shi

et al. 2023

J Neurol Surg Rep

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Introduction Clival tumors are rare and heterogeneous. Although some benign prototypical sellar lesions may present as clival tumors, the likelihood of malignant disease is higher. Here we define a novel algorithm for the workup and management of clival masses through an illustrative case of colorectal adenocarcinoma metastasis to the clivus. Methods In this case report, the best practice guidelines for managing clival masses are described through a literature review and refined by senior author consensus. We conducted a focused systematic review to characterize the present case in the context of clival metastasis from gastrointestinal malignancy. Results An 83-year-old woman presented with 4 weeks of headaches and blurry vision. Examination revealed partial right abducens and left oculomotor palsies. Magnetic resonance imaging (MRI) identified a large, weakly enhancing sellar and clival mass with sphenoid sinus extension. An aggressive subtotal endoscopic endonasal resection was performed with removal of all sphenoid, clival, and sellar disease without cavernous sinus wall resection. Pathology confirmed colorectal adenocarcinoma; computed tomography (CT) imaging identified an ascending colon mass with metastases to the liver and mesenteric nodes. Palliative oncologic therapies were recommended, but she elected hospice, and died 3 months after initial presentation. Gastrointestinal clival metastases are exceedingly rare among sellar and clival pathologies, with eight prior cases reported, most of which presented with diplopia from abducens nerve involvement. Conclusion Clival masses are uncommon skull base lesions that are associated with more aggressive diseases. We present a consolidated framework for decision-making in these challenging patients, alongside an unusual case example that illustrates the importance of increased suspicion for malignant clinical entities in this setting.

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“…The most common clival pathology is chordoma, which accounts for 40% of tumors within this area [25]. Differential diagnoses also include enchondromatous lesions, such as chondrosarcomas, fibrous dysplasia, myelomas, metastases and solitary fibrous tumors, then primary lymphomas and interosseous meningiomas, in order of their incidence in the clival area [26][27][28].…”

Section: The Radiological Differential Diagnosis To Exclude Other Cli...mentioning

confidence: 99%

A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions

Kunicki

Rzewuska

Kunicki³

et al. 2022

Diagnostics

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Leiomyomas are common lesions that are usually located in the genitourinary and gastrointestinal tracts. Primary leiomyomas at the skull base are uncommon. They are composed of well-differentiated smooth muscle cells without cellular atypia. The diagnosis of a leiomyoma has to be confirmed by immunohistochemistry. The tumor tissue is immunoreactive for SMA, S100 and cytokeratin. Leiomyomas mainly occur in immunocompromised patients. Most tumor tissues are positive for EBV. The presented case is that of a 56-year-old immunocompetent woman with a tumor on the clivus. The radiological images suggested chordoma or fibrous dysplasia. Transnasal transsphenoidal surgery was performed. The tumor tissue consisted of well-differentiated smooth muscle cells with elongated nuclei. Immunohistochemistry revealed a positive reaction for desmin, SMA and h-Caldesmon and a negative reaction for S100, beta-catenin, PGR and Ki67. The leiomyoma diagnosis was subsequently established. To the best of our knowledge, the case of a primary leiomyoma on the clivus of an immunocompetent patient is the first to be described. We also extensively reviewed the literature on the immunohistopathological and radiological differential diagnosis of clival lesions.

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Clivus pathologies from diagnosis to surgical multidisciplinary treatment. Review of the literature

Abstract: Clivus pathologies from diagnosis to surgical multidisciplinary treatment. Review of the literature Patologie del clivus dalla diagnosi al trattamento chirurgico multidisciplinare. Revisione della letteratura

Cited by 7 publications

References 41 publications

Pearls & Oy-sters: Sequential Bilateral Hearing and Vision Loss With Optic Disc Swelling Due to Sphenoid Bone Craniofacial Fibrous Dysplasia

Pearls & Oy-sters: Sequential Bilateral Hearing and Vision Loss With Optic Disc Swelling Due to Sphenoid Bone Craniofacial Fibrous Dysplasia

Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example

A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions

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