Abstract
Background
Tumours of the clivus are rare and metastases involving this area have been previously described only as single case reports or included in series with other skull base tumours. Here, we describe seven such examples and review the pertinent literature.
Method
Clinical, radiological and follow-up data of patients who had undergone surgery for clivus tumours at our Institution between January 1995 and December 2007 were retrospectively collected. A literature review was performed using PubMed.
Findings
Of 46 patients who underwent surgery for clivus bone tumours, seven proved to harbour a metastasis. This figure represents 0.18% and 0.42% respectively of intracranial and skull base tumours which were treated in our Institution in the study period. The primary tumours associated were lung adenocarcinoma (n = 2), prostate carcinoma (n = 2), skin melanoma (n = 1), hepatocarcinoma (n = 1) and lung squamous cell carcinoma (n = 1). All patients presented with a sixth nerve palsy as the symptom. Histopathology was obtained via a trans-sphenoidal biopsy. In spite of radiotherapy and chemotherapy, the mean survival was 12 months. On literature review, 27 examples of metastases located in the clival bone were found. Including our series, the most common primary tumours were prostate cancer (26.4%), thyroid carcinoma (11.7%) and hepatocarcinoma (11.7%).
Conclusion
Though exceedingly rare, metastases involving the clivus should be considered in the differential diagnosis with clivus chordoma. The metastatic lesion might be a late and single expression of the primary tumour. The trans-sphenoidal approach is the ideal procedure to establish a histopathological diagnosis. Prognosis is poor.
Similar content being viewed by others
References
Alessi G, Lemmerling M, Vereecken L, De Waele L (2003) Benign metastasising leiomyoma to skull base and spine: a report of two cases. Clin Neurol Neurosurg 105:170–174 doi:10.1016/S0303-8467(03)00002-7
Altman KW, Mirza N, Philippe L (1997) Metastatic follicular thyroid carcinoma to the paranasal sinuses: a case report and review. J Laryngol Otol 111:647–651 doi:10.1017/S0022215100138216
Casals MM, Hunter SB, Olson JJ, Gussack G, Blevins LS Jr (1995) Metastatic follicular thyroid carcinoma masquerading as a chordoma. Thyroid 5:217–221
Endo K, Okano R, Kuroda Y, Yamada S, Tabei K (2001) Renal cell carcinoma with skull base metastasis preceded by paraneoplastic signs in a chronic haemodialysis patient. Intern Med 40:924–930 doi:10.2169/internalmedicine.40.924
Escott EJ (2001) A variety of appearances of malignant melanoma in the head: a review. Radiographics 21:625–639
Gavrilovic IT, Posner JB (2005) Brain metastases: epidemiology and pathophysiology. J Neurooncol 75:5–14 doi:10.1007/s11060-004-8093-6
Greenberg HS, Deck MD, Vikram B, Chu FC, Posner JB (1981) Metastasis to the base of the skull: clinical findings in 43 patients. Neurology 31:530–537
Harada M, Shimizu A, Nakamura Y, Nemoto R (1992) Role of the vertebral venous system in metastatic spread of cancer cells to the bone. Adv Exp Med Biol 324:83–92
Hirai O, Kikuchi H, Hashimoto N (1992) Skull base metastasis from gastric cancer - case report. Neurol Med Chir (Tokyo) 32:908–910 doi:10.2176/nmc.32.908
Jung CS, Zimmermann M, Seifert V (2004) Clivus lymphoma. Acta Neurochir (Wien) 146:533–534 doi:10.1007/s00701-004-0244-1
Kelley TF, Stankiewicz JA, Chow JM, Origitano TC (1999) Endoscopic trans-sphenoidal biopsy of the sphenoid and clival mass. Am J Rhinol 13:17–21 doi:10.2500/105065899781389821
Kim M, Na DL, Park SH, Jeon BS, Roh JK (1998) Nervous system involvement by metastatic hepatocellular carcinoma. J Neurooncol 36:85–90 doi:10.1023/A:1005716408970
Kim SR, Kanda F, Kobessho H, Sugimoto K, Matsuoka T, Kudo M, Hayashi Y (2006) Hepatocellular carcinoma metastasising to the skull base involving multiple cranial nerves. World J Gastroenterol 12:6727–6729
Kingdom TT, Delgaudio JM (2003) Endoscopic approach to lesions of the sphenoid sinus, orbital apex, and clivus. Am J Otolaryngol 24:317–322 doi:10.1016/S0196-0709(03)00062-0
Kocak Z, Celik Y, Uzal MC, Uygun K, Kaya M, Albayram S (2003) Isolated bilateral sixth nerve palsy secondary to metastatic carcinoma: a case report with a review of the literature. Clin Neurol Neurosurg 106:51–54 doi:10.1016/j.clineuro.2003.07.002
Korten AG, ter Berg HJ, Spincemaille GH, van der Laan RT, Van de Wel AM (1998) Intracranial chondrosarcoma: review of the literature and report of 15 cases. J Neurol Neurosurg Psychiatry 65:88–92 doi:10.1136/jnnp.65.1.88
Laigle-Donadey F, Taillibert S, Martin-Duverneuil N, Hildebrand J, Delatore JY (2005) Skull-base metastases. J Neurooncol 75:63–69 doi:10.1007/s11060-004-8099-0
Maira G, Pallini R, Anile C, Fernandez E, Salvinelli F, La Rocca LM, Rossi GF (1996) Surgical treatment of clival chordomas: the trans-sphenoidal approach revisited. J Neurosurg 85:784–792
Malloy KA (2007) Prostate cancer metastasis to clivus causing cranial nerve VI palsy. Optometry 78:55–62 doi:10.1016/j.optm.2006.08.015
McDermott RS, Anderson PR, Greenberg RE, Milestone BN, Hudes GR (2004) Cranial nerve deficits in patients with metastatic prostate carcinoma: clinical features and treatment outcomes. Cancer 101:1639–1643 doi:10.1002/cncr.20553
McGirt MJ, Cowan JA Jr, Gala V, Garton HJ, Muraszko KM, Thompson BG (2005) Surgical reversal of prolonged blindness from a metastatic neuroblastoma. Childs Nerv Syst 21:583–586 doi:10.1007/s00381-004-1062-8
O’Boyle JE, Gardner TA, Oliva A, Enzenauer RW (1992) Sixth nerve palsy as the initial presenting sign of metastatic prostate cancer. A case report and review of the literature. J Clin Neuroophthalmol 12:149–153
Pallini R, Maira G, Pierconti F, Falchetti ML, Alvino E, Cimino-Reale G, Fernandez E, D’Ambrosio E, Larocca LM (2003) Chordoma of the skull base: predictors of tumour recurrence. J Neurosurg 98:812–822
Rosahl SK, Erpenbeck V, Vorkapic P, Samii M (2000) Solitary follicular thyroid carcinoma of the skull base and its differentiation from ectopic adenoma - review, use of galectin-3 and report of a new case. Clin Neurol Neurosurg 102:149–155 doi:10.1016/S0303-8467(00)00088-3
Ruchti C, Balli-Antunes M, Gerber HA (1987) Follicular tumour in the sellar region without primary cancer of the thyroid. Heterotopic carcinoma? Am J Clin Pathol 87:776–780
Salas E, Sekhar LN, Ziyal IM, Caputy AJ, Wright DC (1999) Variations of the extreme-lateral cranio-cervical approach: anatomical study and clinical analysis of 69 patients. J Neurosurg 90:206–219
Sim RST, Tan HKK (1994) A case of metastatic hepatocellular carcinoma of the sphenoid sinus. J Laryngol Otol 108:503–504 doi:10.1017/S0022215100127239
Turner JL, Sweeney P, Hardy R (1980) Ewing’s tumour metastatic to the clivus, simulating meningitis: case report. Neurosurgery 7:619–620 doi:10.1097/00006123-198012000-00017
Ulubas B, Ozcan C, Acka G, Aydn O, Sarita ÅŸE (2005) Clivus metastasis of squamous cell carcinoma: a rare location. J Clin Neurosci 12:97–98 doi:10.1016/j.jocn.2003.12.015
Wong ET, Lu XQ, Devulapalli J, Mahadevan A (2006) Cyberknife radiosurgery for basal skull plasmacytoma. J Neuroimaging 16:361–363
Author information
Authors and Affiliations
Corresponding author
Additional information
Comment
Metastatic clival tumors are rare, and usually reported as single cases (27 in the literature). This retrospective analysis describes an interesting series of seven consecutive patients treated between 1995 and 2007 with a very simple protocol: transphenoidal biopsy, radio-chemotherapy. Results are reasonably fair, provided the poor prognosis of these specific location.
Massimo Gerosa
University of Verona
Rights and permissions
About this article
Cite this article
Pallini, R., Sabatino, G., Doglietto, F. et al. Clivus metastases: Report of seven patients and literature review. Acta Neurochir 151, 291–296 (2009). https://doi.org/10.1007/s00701-009-0229-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-009-0229-1