Download PDF
CC BY-NC-ND 4.0 · J Neurol Surg Rep 2023; 84(04): e156-e162
DOI: 10.1055/a-2215-0974
Original Report

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

Matthew P. Baier 
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Daniel A. Cheong
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Helen H. Shi
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Jo Elle G. Peterson
2   Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Kar-Ming Fung
2   Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Ian F. Dunn
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Kibwei A. McKinney
3   Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Christopher S. Graffeo 
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

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.

Keywords

clivus - sella - metastasis - colorectal adenocarcinoma


Publication History

Received: 22 September 2023

Accepted: 30 October 2023

Accepted Manuscript online:
21 November 2023

Article published online:
20 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Gagliardi F, Boari N, Mortini P. Solitary nonchordomatous lesions of the clival bone: differential diagnosis and current therapeutic strategies. Neurosurg Rev 2013; 36 (04) 513-522 , discussion 522
    CrossrefPubMedGoogle Scholar
  • 2 Rodrigues J, da Silva FM, Mangussi-Gomes J. et al. Differential diagnosis of clival lesions: literature review of the clinical and radiological features. Ann Otolaryngol Rhinol 2017; 4 (09) 1200
    PubMedGoogle Scholar
  • 3 Chapman PR, Singhal A, Gaddamanugu S, Prattipati V. Neuroimaging of the pituitary gland: practical anatomy and pathology. Radiol Clin North Am 2020; 58 (06) 1115-1133
    CrossrefPubMedGoogle Scholar
  • 4 Chen X, Dai J, Ai L. et al. Clival invasion on multi-detector CT in 390 pituitary macroadenomas: correlation with sex, subtype and rates of operative complication and recurrence. AJNR Am J Neuroradiol 2011; 32 (04) 785-789
    CrossrefPubMedGoogle Scholar
  • 5 Jozsa F, Das JM. Metastatic lesions of the clivus: a systematic review. World Neurosurg 2022; 158: 190-204
    CrossrefPubMedGoogle Scholar
  • 6 Neelakantan A, Rana AK. Benign and malignant diseases of the clivus. Clin Radiol 2014; 69 (12) 1295-1303
    CrossrefPubMedGoogle Scholar
  • 7 Pagella F, Ugolini S, Zoia C. et al. Clivus pathologies from diagnosis to surgical multidisciplinary treatment. Review of the literature. Acta Otorhinolaryngol Ital 2021; 41 (Suppl. 01) S42-S50
    CrossrefPubMedGoogle Scholar
  • 8 Shindorf ML, Jafferji MS, Goff SL. Incidence of asymptomatic brain metastases in metastatic colorectal cancer. Clin Colorectal Cancer 2020; 19 (04) 263-269
    CrossrefPubMedGoogle Scholar
  • 9 Go PH, Klaassen Z, Meadows MC, Chamberlain RS. Gastrointestinal cancer and brain metastasis: a rare and ominous sign. Cancer 2011; 117 (16) 3630-3640
    CrossrefPubMedGoogle Scholar
  • 10 Lubomirsky B, Jenner ZB, Jude MB, Shahlaie K, Assadsangabi R, Ivanovic V. Sellar, suprasellar, and parasellar masses: imaging features and neurosurgical approaches. Neuroradiol J 2022; 35 (03) 269-283
    CrossrefPubMedGoogle Scholar
  • 11 Chin BM, Orlandi RR, Wiggins III RH. Evaluation of the sellar and parasellar regions. Magn Reson Imaging Clin N Am 2012; 20 (03) 515-543
    CrossrefPubMedGoogle Scholar
  • 12 Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA 2017; 317 (05) 516-524
    CrossrefPubMedGoogle Scholar
  • 13 Jipa A, Jain V. Imaging of the sellar and parasellar regions. Clin Imaging 2021; 77: 254-275
    CrossrefPubMedGoogle Scholar
  • 14 Beddok A, Scher N, Alapetite C. et al. Proton therapy for adult craniopharyngioma: experience of a single institution in 91 consecutive patients. Neuro-oncol 2023; 25 (04) 710-719
    CrossrefPubMedGoogle Scholar
  • 15 Brastianos PK, Twohy E, Geyer S. et al. BRAF-MEK inhibition in newly diagnosed papillary craniopharyngiomas. N Engl J Med 2023; 389 (02) 118-126
    CrossrefPubMedGoogle Scholar
  • 16 Oushy S, Graffeo CS, Perry A, Morris JM, Carlson ML, Van Gompel JJ. Collet-Sicard syndrome attributable to extramedullary plasmacytoma of the jugular foramen. World Neurosurg 2018; 110: 386-390
    CrossrefPubMedGoogle Scholar
  • 17 Kilciksiz S, Karakoyun-Celik O, Agaoglu FY, Haydaroglu A. A review for solitary plasmacytoma of bone and extramedullary plasmacytoma. ScientificWorldJournal 2012; 2012: 895765
    CrossrefPubMedGoogle Scholar
  • 18 Deconde AS, Sanaiha Y, Suh JD, Bhuta S, Bergsneider M, Wang MB. Metastatic disease to the clivus mimicking clival chordomas. J Neurol Surg B Skull Base 2013; 74 (05) 292-299
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Lee A, Chang KH, Hong H, Kim H. Sixth cranial nerve palsy caused by gastric adenocarcinoma metastasis to the clivus. J Korean Neurosurg Soc 2015; 57 (03) 208-210
    CrossrefPubMedGoogle Scholar
  • 20 Lee C, Thon JM, Dhand A. Clival metastasis from a gastrointestinal adenocarcinoma causing multiple cranial neuropathies. BMJ Case Rep 2017; 2017: bcr-2017–222725
    CrossrefPubMedGoogle Scholar
  • 21 Dekker SE, Wasman J, Yoo KK. et al. Clival metastasis of a duodenal adenocarcinoma: a case report and literature review. World Neurosurg 2017; 100: 62-68
    CrossrefPubMedGoogle Scholar
  • 22 Yoshikawa-Kimura A, Taira K, Katanosaka Y. et al. A rare case of clival metastasis in a patient with gastric cancer. Intern Med 2020; 59 (24) 3161-3164
    CrossrefPubMedGoogle Scholar
  • 23 Kendre B, Deopujari C, Karmarkar V, Ratha V. A rare case of carcinoma rectum metastasing to clivus. Neurol India 2014; 62 (01) 85-86
    CrossrefPubMedGoogle Scholar
  • 24 Fukushima M, Katayama Y, Shigemori Y, Miyake H, Hirayama T, Kotani A. Clivus metastasis from gastric signet ring cell carcinoma after a 10-year disease-free interval: case report. Neurol Med Chir (Tokyo) 2012; 52 (10) 751-753
    CrossrefPubMedGoogle Scholar
  • 25 Baeg MK, Bae SH, Lee KH, Kim J, Park IS, Jin J-Y. Diplopia as a presenting symptom in a gastric gastrointestinal stromal tumor. Jpn J Clin Oncol 2011; 41 (02) 265-268
    CrossrefPubMedGoogle Scholar
  • 26 Barrière J, Thariat J, Vandenbos F, Bondiau PY, Peyrottes I, Peyrade F. Diplopia as the first symptom of an aggressive metastatic rectal stromal tumor. Onkologie 2009; 32 (06) 345-347
    CrossrefPubMedGoogle Scholar