Endoscopic Endonasal Treatment of a Large Clival Giant Cell Tumor Invading the Cavernous Sinus and Temporal Lobe

Abstract

Giant cell tumors (GCTs) are extremely rare lesions, representing less than 5% of all bone tumors. They primarily occur in the long bones. However, a small percentage of these tumors occur in the pelvis, spine, or skull bones. These lesions are usually benign as well as locally aggressive and require complete removal. Nowadays, GCT and other skull base lesions can be treated using the extended endoscopic endonasal approach. We present a case report of a GCT located in the skull base, originating from the clivus and sphenoid bone, invading through the cavernous sinus, and treated using the fully endoscopic endonasal approach.

A rare case of giant cell tumor involving the clivus resected through Le Fort I Osteotomy and median maxillotomy

“…EEA is a newer, less invasive approach for clival GCTs, with reported advantages of better visualization by placing the lens and light source closer to the mass and lateral visualization with angled endoscopes. [ 5 11 ] Despite these reported advantages, EEA would have been challenging in our patient with a history of five previous nasal fractures and a deviated septum. In addition, an advantage of the extended transoral approach includes direct visualization of the clival mass in the center of the surgical field with neurovascular structures placed laterally, maximizing our ability to safely obtain a gross total resection.…”

“…Reported cases of clival GCTs describe a transnasal, transmaxillary, or endoscopic endonasal approach (EEA) for resection. [ 5 7 8 11 ] We describe a GCT involving the clivus removed by a Le Fort I osteotomy (LFO) and median maxillotomy (MM) approach.…”

Denosumab Treatment for a Residual Giant Cell Tumor of the Clivus: A Case Report and Review of the Literature

“…Overall, this lesion is more common in females, and usually occurs in the young adults. While generally considered a benign tumor, metastasis to the lungs can be seen in up to 5% of cases, and transformation to malignant sarcoma has been described [1][2][3] . The most common presenting symptoms for GCTs of the clivus are headache, diplopia, and cranial nerve palsies with normal endocrinologic function 1 .…”

“…The low incidence of skull base GCTs not only makes the definitive diagnosis more difficult, but also presents challenges as far as recommended treatments. There are no defined guidelines for the treatment of these lesions, but the mainstay of treatment has been gross total surgical resection and drilling of surrounding healthy bone 2 . Due to the challenging location of these tumors, however, complete resection is often not possible, which can result in residual or recurrent tumor.…”

Unresectable Clival Giant Cell Tumor, Tumor Control With Denosumab After Relapse: A Case Report and Systematic Review of the Literature

“…In 4 cases, a complete resection was achieved without residual disease; for these patients, surgery was the only treatment performed except for one who also underwent radiotherapy. 17 All the remaining patients underwent subtotal or partial resections; these patients received further treatment as adjuvant therapy or to treat a relapse or progression of the disease. Radiotherapy was the most commonly treatment used (13/25, 52%) as an adjuvant therapy, except in our case where a systemic treatment with denosumab was started following surgery.…”