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Kobayashi Y, Satoh S, Kishida Y, Goto H, Fujimori D, Onuki A, Watanabe K, Tomura N. Primary intraosseous cavernous hemangioma of the clivus: A case report and literature review. Surg Neurol Int 2024; 15:177. [PMID: 38840598 PMCID: PMC11152543 DOI: 10.25259/sni_106_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
Background The radiographic presentation of the primary intraosseous cavernous hemangiomas (PICHs) is nonspecific. We report a case of clival PICH mimicking a chordoma with a literature review. Case Description A 57-year-old woman presented with diplopia that started a few days before the presentation. She had transient diplopia at the right lateral gaze and upper gaze with normal eye movement. The symptoms disappeared spontaneously 1 week later. She had no other complaints or neurological deficits. Computed tomography revealed an intraosseous mass lesion and bone erosion of the middle and lower clivus, extending laterally to the right occipital condyle. Magnetic resonance imaging (MRI) showed hyperintense and hypointense components on T2- and T1-weighted images, respectively. The lesion was larger than on MRI performed 10 years earlier. Chordoma or chondroma was considered a possible preoperative diagnosis. An endoscopic transsphenoidal approach removed the tumor. In the operating view, the lesion appeared as "moth-eaten" bony interstices filled with vascular soft tissue. Histologically, an intraosseous cavernous hemangioma was diagnosed. Conclusion Diagnosis before surgery is difficult without characteristic radiographic findings. When making a differential diagnosis of malignant skull lesions, PICH should be considered.
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Affiliation(s)
- Yuta Kobayashi
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Shunsuke Satoh
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Yugo Kishida
- Department of Neurosurgery, Tokyo D Tower Hospital, Koto-Ku, Japan
| | - Hiromi Goto
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Daichi Fujimori
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Akinori Onuki
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Kazuo Watanabe
- Department of Neurosurgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Noriaki Tomura
- Department of Neuroradiology, Southern Tohoku General Hospital, Koriyama, Japan
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Kumarasamy S, Kumar A, Singh PK, Suri A, Chandra PS, Kale SS. Non-chordomatous clival bony tumors: A rare experience and systematic literature review. Childs Nerv Syst 2024; 40:1065-1077. [PMID: 38051310 DOI: 10.1007/s00381-023-06237-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Non-chordomatous bony tumors of the clivus are extremely rare. Site, extent, and aggressiveness of tumor limits the extent of resection. It poses challenge to the neurosurgeons due to the complexity of anatomy. There is paucity of literature exclusively on non-chordomatous bone tumors of the clivus in young adults. OBJECTIVES To analyze the clinical presentation, imaging findings, surgical approach, complications, and outcome of primary clival bony tumors in young adults. METHODS We retrospectively reviewed children and young adults with primary clival bony tumors excluding chordoma who underwent surgical resection between years 2010 and 2023 in our center. We analyzed the demographic details, imaging findings, operative variables, perioperative complications, length of stay, complications, and outcome at latest follow-up. RESULTS The mean age was 17.5 ± 1.73 years (range 16 to 19 years). Headache was the presenting complaint in all four patients (100%). The mean duration of symptom was 7.25 ± 3.2 months (range 5 to 12 months). The tumor was localized in clivus in all four patients (100%). The mean length of stay in hospital was 30.5 ± 13.48 days (range 11 to 40 days). All patients underwent surgical treatment. Surgical approaches used were anterior approach in four patients (100%). Gross total excision was performed in one patient (25%), sub-total excision was performed in two patients (50%), and tumor decompression was performed in one patient (25%). Of these, three were designated as having benign tumors and one had a malignant tumor. There was no perioperative mortality. There was one mortality (25%) on 2 months follow-up due to tumor progression. Three patients (75%) had improved symptomatically at latest follow-up. Two patients (50%) received adjuvant chemoradiotherapy. The mean follow-up was 38 ± 39.29 months (range 2 to 72 months). CONCLUSION Non-chordomatous bony tumors of the clivus are rare and often underestimated. Surgery is the treatment of choice. Tumor consistency and adhesion to critical neurovascular structures precludes gross total resection. Various approaches are in the armamentarium. Approach to be decided based on the expertise of the neurosurgeon to achieve safe maximal resection. Multidisciplinary approach is mandatory for streamlined management. Adjuvant therapy is decided based on the residual tumor following surgery.
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Affiliation(s)
- Sivaraman Kumarasamy
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Amandeep Kumar
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Ashish Suri
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Poodipedi Sarat Chandra
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
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Cao X, Chen X, Wang Y, Feng S, Wang Z. Case report: Cavernous hemangioma in the right frontoparietal junction. Front Surg 2022; 9:972641. [PMID: 36111232 PMCID: PMC9468221 DOI: 10.3389/fsurg.2022.972641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Primary intraosseous cavernous hemangioma is a benign tumor with slow growth and is rarely seen in clinics. The clinical manifestations of most patients are progressive enlargement of the head mass. Case presentation We report a 30-year-old female patient with cavernous hemangioma at the frontoparietal junction. Upon admission, the right frontal lobe mass was progressively enlarged for 3 years and underwent lesion resection and stage I skull reconstruction. The postoperative outcome was good, with no recurrence at 1-year follow-up. Conclusion Primary intraosseous cavernous hemangioma is a relatively rare clinical tumor, the pathogenesis of which is still unclear, and most of them have no specific clinical manifestations. Characteristic imaging findings are highly suspicious of this disease, but the definitive diagnosis still depends on histopathological examination. Currently, total surgical resection of the tumor is a relatively effective and preferred treatment.
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Affiliation(s)
- Xuemin Cao
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- These authors share first authorship
| | - Xiaoshuai Chen
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- These authors share first authorship
| | - Yi Wang
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Shangang Feng
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Zengwu Wang
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
- Correspondence: Zengwu Wang
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Van de Voorde N, Mortier GR, Vanhoenacker FM. Fibrous Dysplasia, Paget's Disease of Bone, and Other Uncommon Sclerotic Bone Lesions of the Craniofacial Bones. Semin Musculoskelet Radiol 2020; 24:570-578. [PMID: 33036044 DOI: 10.1055/s-0039-3400292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Imaging studies of the brain, head and neck, sinuses, and dental computed tomography are among the most frequently performed procedures in radiologic departments. Systematic evaluation in the bone window may reveal common and uncommon sclerotic osseous abnormalities of the craniofacial skeleton.Most of these findings are incidental and unrelated to the initial clinical indications. Sporadically symptoms may arise due to lesional mass effect with compression on adjacent structures and neuroforaminal encroachment, resulting in proptosis, vision, or hearing loss. Other symptoms include craniofacial deformity, mandibular occlusion deformity, and local pain.This article reviews the most common disorders characterized by an increased bone density involving the craniofacial bones including fibrous dysplasia, Paget's disease of bone, meningioma with associated hyperostosis, and osteoma. Finally, typical examples of rarer sclerosing bone dysplasias are discussed as well.Emphasis is placed on imaging features and the differential diagnosis.
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Affiliation(s)
- Nick Van de Voorde
- Department of Radiology, Antwerp University Hospital and Antwerp University, Edegem, Belgium
| | - Geert R Mortier
- Department of Medical Genetics, Antwerp University Hospital and Antwerp University, Edegem, Belgium
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital and Antwerp University, Edegem, Belgium.,Department of Medical Genetics, Antwerp University Hospital and Antwerp University, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium.,Department of Radiology and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Mezmezian MB, Arakaki N, Fallaza Moya S, Solé H, Olvi L. Petroclival intravascular papillary endothelial hyperplasia with psammoma body-like structures. Neuropathology 2019; 40:268-274. [PMID: 31802551 DOI: 10.1111/neup.12629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 11/27/2022]
Abstract
Masson's tumor or intravascular papillary endothelial hyperplasia (IPEH) is considered a non-neoplastic lesion. It is probably an unusual exaggerated reorganization of a thrombus. IPEH may be present as a secondary lesion in hemangiomas. Symptomatic osseous hemangiomas are rare tumors. Few cases of clival and petrous bone hemangiomas have been described. None of them shows secondary IPEH. So far, there are only four reported cases of cranial bone IPEHs in the literature, two in the skull, one in the clivus and one in the petrous apex. The aim of this study is to report an additional case of osseous hemangioma with secondary IPEH of the petroclival region. We review the literature and describe the main clinical features of IPEHs and hemangiomas of the clivus and the petrous bone. Additionally, we report an unusual histological feature observed in our case of IPEH, the presence of psammoma body-like structures. This feature has been rarely mentioned previously in IPEH. We consider that IPEH should be included in the lesions that may present psammoma bodies to avoid misdiagnosing it as a tumor that commonly shows psammoma bodies, such as intraosseous meningioma or, less frequently, metastasis of thyroid or ovarian carcinoma.
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Affiliation(s)
| | - Naomi Arakaki
- Neuropathology Department, FLENI, Buenos Aires, Argentina
| | | | - Horacio Solé
- Unit of Neurosurgery, Hospital Pirovano, Buenos Aires, Argentina
| | - Liliana Olvi
- Laboratory of Orthopaedic Pathology, Buenos Aires, Argentina
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Serrano L, Archavlis E, Januschek E, Ulrich PT. High risk of cerebrospinal fluid leakage in surgery of a rare primary intraosseous cavernous hemangioma of the clivus showing meningeal infiltration: A case report and review of the literature. Surg Neurol Int 2015; 6:S117-23. [PMID: 25949853 PMCID: PMC4408619 DOI: 10.4103/2152-7806.155695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/27/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Primary intraosseous cavernous hemangiomas (PICH) of the skull represent an infrequent bone tumor. Although some rare cases of PICHs located in the skull base have been published, to our concern only three cases have been reported in the English literature of PICHs arising within the clivus. CASE DESCRIPTION We present the case of a patient presenting an isolated abducens paresis due to a rare PICH of the clivus showing also an unusual destruction of the inner table as well as infiltration of the dura mater. Due to this uncommon infiltrative pattern of an otherwise expected intraosseous tumor, a cerebrospinal fluid (CSF)-fistula occurred while performing a transnasal biopsy. The patient recovered successfully without need of lumbar drainage or re-surgery. Additionally, intratumoral decompression was sufficient to relief the abducens paresis. CONCLUSIONS Our case provides new and meaningful information about clinical features as well as growth pattern of these rare clival tumors. We also discuss the importance of knowing these peculiarities before surgery in order to plan the optimal operative management as well as to avoid complications while approaching PICHs localized in such a delicate cranial region.
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Affiliation(s)
- Lucas Serrano
- Department of Neurosurgery, Sana Offenbach Hospital, University of Frankfurt am Main affiliated Hospitals, Starkenburgringstr. 66, 63069 Offenbach am Main, Germany
| | - Eleftherios Archavlis
- Department of Neurosurgery, Sana Offenbach Hospital, University of Frankfurt am Main affiliated Hospitals, Starkenburgringstr. 66, 63069 Offenbach am Main, Germany
| | - Elke Januschek
- Department of Neurosurgery, Sana Offenbach Hospital, University of Frankfurt am Main affiliated Hospitals, Starkenburgringstr. 66, 63069 Offenbach am Main, Germany
| | - Peter T Ulrich
- Department of Neurosurgery, Sana Offenbach Hospital, University of Frankfurt am Main affiliated Hospitals, Starkenburgringstr. 66, 63069 Offenbach am Main, Germany
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Gagliardi F, Spina A, Boari N, Narayanan A, Mortini P. Solitary lesions of the clivus: what else besides chordomas? An extensive clinical outlook on rare pathologies. Acta Neurochir (Wien) 2015; 157:597-605; discussion 605. [PMID: 25591803 DOI: 10.1007/s00701-014-2340-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/29/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Solitary non-chordomatous lesions of the clivus are rare pathologies, which represent a diagnostic challenge. This study provides an overview of the clinical, radiological and prognostic characteristics of non-chordomatous clival lesions, highlighting current therapeutic options. METHODS Twenty-two non-chordomatous lesions of the clivus were collected. A retrospective analysis of clinical and radiological patterns as well as survival data was conducted. RESULTS Clinical presentation was a result of local mass effect. Imaging features, although mainly specific, were not always diagnostic. Extent of surgery was gross total in 45.5 % of cases. Depending on the histology, biological behaviour and presence of seeding, adjuvant treatment was performed, tailoring the treatment strategy to the single patient. CONCLUSIONS Solitary non-chordomatous lesions of the clival bone are more prevalent than expected. They should be approached with a correct differential diagnosis, considering specific epidemiological, radiological, and histopathological characteristics, to minimise diagnostic bias and allow the planning of the best treatment strategy.
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Gologorsky Y, Shrivastava RK, Panov F, Mascitelli J, Signore AD, Govindaraj S, Smethurst M, Bronster DJ. Primary intraosseous cavernous hemangioma of the clivus: case report and review of the literature. J Neurol Surg Rep 2013; 74:17-22. [PMID: 23943715 PMCID: PMC3713557 DOI: 10.1055/s-0033-1346980] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 02/19/2013] [Indexed: 11/03/2022] Open
Abstract
Primary intraosseous hemangiomas are benign, vascular malformations that account for approximately 1% of all primary bone neoplasms. These tumors are mostly found in vertebral bodies and are rarely seen in the calvarium, where they represent 0.2% of bony neoplasms. When found in the skull, they tend to present with vague symptoms and do not have the typical radiological findings suggestive of hemangiomas. Because of this, these tumors can be missed in many cases or may be misinterpreted as more ominous lesions like multiple myeloma or osteosarcoma. Involvement of the skull base is exceedingly rare, and presentation with cranial nerve unilateral polyneuropathies has not been reported. We report a patient case with review of recent pertinent literature.
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Affiliation(s)
- Yakov Gologorsky
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, USA
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9
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Solitary nonchordomatous lesions of the clival bone: differential diagnosis and current therapeutic strategies. Neurosurg Rev 2013; 36:513-22; discussion 522. [DOI: 10.1007/s10143-013-0463-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/21/2013] [Accepted: 01/21/2013] [Indexed: 12/23/2022]
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Rumana M, Khursheed N, Farhat M, Othman S, Masood L. Congenital intraosseous cavernous hemangioma of the skull: an unusual case. Pediatr Neurosurg 2013; 49:229-31. [PMID: 25060919 DOI: 10.1159/000363328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/30/2014] [Indexed: 11/19/2022]
Abstract
Intraosseous hemangiomas are benign vascular malformations mostly seen in the spine. They rarely occur in the skull. The usual age-group involved is the 2nd to 4th decades, and females outnumber males. We hereby report a rare case of congenital intraosseous cavernous hemangioma of the skull bone in a male infant. The patient underwent total excision of the lesion.
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Affiliation(s)
- Makhdoomi Rumana
- Department of Pathology, Sheri-Kashmir Institute of Medical Sciences, Kashmir, India
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