Clival Metastasis Research Articles

An unusual case of aggressive endometrial adenocarcinoma metastasis to the clivus: illustrative case.

Though endometrial carcinomas are a relatively common cancer of the female genitourinary tract, they rarely metastasize. Similarly, clival metastases make up a tiny fraction of all brain metastases. To the authors' knowledge, an endometrial carcinoma clival metastasis has never been described in the literature; therefore, the authors present the following unusual case of a 69-year-old female with a history of an initially grade 2 endometrial adenocarcinoma that metastasized to her clivus. Endometrial carcinoma has the potential to metastasize to the clivus. Endometrial carcinoma, even when initially low grade, can metastasize intracranially. Prompt diagnosis with tissue biopsy and radiation is the mainstay of treatment, although the prognosis remains poor. https://thejns.org/doi/10.3171/CASE24392.

Clival Metastases: Single-Center Retrospective Case Series and Literature Review.

Background/Objectives: Clivus metastases from distant neoplasms are uncommon occurrences both in clinical practice and the neurosurgical literature. Surgical management is debated, particularly about the role of surgery and the preferable approach. The aim of this study was to report our surgical experience and review the concerning literature. Methods: Our institutional registry was retrospectively reviewed, and patients who underwent surgical treatment for clival metastasis from 1998 to 2023 were included. A PRISMA systematic review of the literature was performed. Results: Four patients were enrolled, and all of them underwent an endoscopic endonasal approach (EEA). Three presented with cranial nerve (CN) VI palsy. The aim of surgery was biopsy in all cases. No complications were reported. Mean overall survival (OS) was 6 ± 1 months. The systematic review retrieved 27 papers reporting 39 patients who underwent the surgical treatment of clivus metastases. Most of them (79.5%) presented with CN palsies, and EEA was the preferred approach in 92.3% of the cases, to perform a biopsy in most patients (59%). Two hemorrhagic complications (5.1%) were reported, and the mean OS was 9.4 ± 5.6 months. Conclusions: Clival metastases are uncommonly observed, in most cases, during advanced stages of oncological disease. The aim of surgery should be the confirmation of diagnosis and symptomatic relief, balancing the risk-benefit ratio in a multidisciplinary context. EEA is the approach of choice, and it should be carried out in experienced tertiary skull base centers.

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

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.

Clival Metastasis from Primary Cervical Carcinoma- Rare Lesion

Clival Metastasis from Primary Cervical Carcinoma- Rare Lesion

Clival Metastasis from Lung Primary

Clivus is a rare location for metastasis. We report a patient with lung cancer presented to us with diplopia and headache. He was found to have clival metastasis and treated with palliative radiation therapy to clivus. Metastasis is also a differential to be considered when patients present with clival lesion.

Isolated Clivus Metastasis as the First Presentation of Relapse Breast Cancer: A Case Report and Literature Review

The clivus is situated at an anatomically critical location next to brainstem and the majority of the cranial nerves and involved in approximately 1% of intracranial tumors. Isolated metastase to clivus have been rarely reported in breast cancer. We report a case of 58 year old women, who present a cranialnerve palsy as the first presentation of isolated clival metastasis in a treated patient of breast cancer. The etiology was obteined by brain CT, magnetic resonance imaging (MRI) which showed lesion in the clivus. The diagnosis of clival metastasis from breast cancer was confirmed by transsphenoidal biopsy. The patient received radiotherapy with corticotherapy with favorable evolution within 5 days.

CLIVAL METASTASES CAUSING DIPLOPIA - AN UNUSUAL PRESENTATION OF BRONCHOGENIC CARCINOMA

Lung Cancer is the most common cancer worldwide with most cases being detected at Stage IV. Among these, metastases to the clivus are rare with only very few cases reported in literature. The long course of the abducent nerve in relation to the clivus, makes it susceptible for metastases and subsequent lateral rectus palsy. We present the case of a heavy smoker, 64 years old man who presented with headache and diplopia, on evaluation diagnosed as bronchogenic carcinoma with clival metastases on magnetic resonance imaging(MRI).

Unusual Spread of Renal Cell Carcinoma to the Clivus with Cranial Nerve Deficit

Renal cell carcinoma (RCC) has unusual presentation affecting elderly males with a smoking history. The incidence of RCC varies while the incidence of spread of RCC to the clivus is rare. The typicality of RCC presentation includes hematuria, flank pain, and a palpable flank mass; however, RCC can also present with clival metastasis. The unique path of the abducens nerve in the clivus makes it susceptible to damage in metastasis. We report a case of a 54-year-old African American female that was evaluated for back pain, weakness, numbness, and tingling of bilateral lower extremities and subsequently disconjugate gaze and diplopia. Brain MRI confirmed metastasis to the clivus. She was started on radiotherapy and was planned for chemotherapy and transfer to a nursing home. When a patient presents with sudden unusual cranial nerve pathology, the possibility of metastatic RCC should be sought.

P12.09 * MALIGNANT TUMORS OF ANTERIOR SKULL BASE: IS THE ROLE OF SURGERY ENHANCED IN THE ENDOSCOPY ERA?

INTRODUCTION: Malignant tumors of anterior skull base represent a surgical challenge because of their anatomical location, the necessity of achieving negative margins, and the often-cosmetically disfiguring transfacial approaches needed. Recently, expanded endonasal endoscopic approaches (EEEA) have been developed, either alone or combined with transcranial approaches for treatment of these malignant lesions. We report our experience to illustrate the relative safety and effectiveness of the EEEA for skull base malignancies alone or combined when possible with minimally invasive approaches or traditional surgery. METHODS: From June 2009, 13 patients harbouring malignant neoplastic lesions of anterior skull base were treated at our department. Four patients affected by sinonasal malignancies with extension in anterior cranial fossa underwent to combined open subfrontal or minimally invasive supra orbital approach and EEEA. In 2 patients with respectively esthesioneuroblastoma and maxillary sinus squamous cell carcinoma a combined supraorbital key-hole craniotomy and EEEA were perfomed. Seven clival metastases with VI cranial nerve palsy were approached by the EEEA supplemented by neuronavigation. RESULTS: Gross total removal was performed in 9 out of 13 patients. In the other cases partial resection, but with adequate decompression and diagnosis were achieved. There were no mortality, 1 patient had infection and 1 deep vein thrombosis. CONCLUSIONS: In our experience EEEA are an integral part of the neurosurgical armamentarium for the treatment of the skull base malignancies. In properly selected cases, it affords similar oncologic outcomes with lower morbidity than traditional open approaches. The major potential advantage of the EEEA approach is direct “natural” anatomical route to the lesion without traversing any major neurovascular structures, so obviating brain retraction. Many tumors grow in a medial-to-lateral direction, displacing structures laterally as they expand, creating natural corridors for their resection via an antero-medial approach. The complementary information provided by endoscopy can assist the surgeon in safely extend the approach maximizing the extent of resection and decompression in hidden angles. Nonetheless, these minimal access approaches should be considered a complement to well-established open approaches, which are still necessary in most advanced tumors.

Improving the endoscopic endonasal transclival approach: the importance of a precise layer by layer reconstruction

Background. The endoscopic endonasal transclival approach (EETCA) is a minimally-invasive technique allowing a direct route to the base of implant of clival lesions with reduced brain and neurovascular manipulation. On the other hand, it is associated with potentially severe complications related to the difficulties in reconstructing large skull base defects with a high risk of postoperative cerebrospinal fluid (CSF) leakage. The aim of this paper is to describe a precise layer by layer reconstruction in the EETCA including the suture of the mucosa as an additional reinforcing layer between cranial and nasal cavity in order to speed up the healing process and reduce the incidence of CSF leak. Methods. This closure technique was applied to the last six cases of EETCA used for clival meningiomas (2), clival chordomas (2), clival metastasis (1), and craniopharyngioma with clival extension (1). Results. After a mean follow-up of 6 months we had no one case of postoperative CSF leakage or infections. Seriated outpatient endoscopic endonasal controls showed a fast healing process of nasopharyngeal mucosa with less patient discomfort. Conclusions. Our preliminary experience confirms the importance of a precise reconstruction of all anatomical layers violated during the surgical approach, including the nasopharygeal mucosa.