Abstract
BACKGROUND AND IMPORTANCE: Cocaine-induced midline destructive lesions manifest as various degrees of distortion to normal anatomy. We present a rare case of substance-induced clival defect that underwent surgical repair. CLINICAL PRESENTATION: This patient presented with transient neurological deficits and was found to have severe clival destruction and pontine pneumatosis secondary to prolonged cocaine use. Surgical reconstruction of the clival defect was performed using a combined open and endoscopic approach. DISCUSSION: When anatomical integrity is severely compromised, defects of the clival region can be repaired using a hybrid open-endoscopic approach. In this case, the lack of local mucosal tissue for reconstruction led to the use of a pedicled pericranial flap. CONCLUSION: Complete clival resorption secondary to cocaine use is uncommon. In advanced cases, pontine inflammation is present on imaging studies. Combined endoscopic and open clival reconstruction is effective in restoring anatomic integrity.
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