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

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.

Petroclival intravascular papillary endothelial hyperplasia with psammoma body‐like structures

“…Our patient showed symptoms related to both locations. Including our case, the cavernous variant of the hemangioma was observed in 14 out of 18 cases (78%) of clival and petrous bone hemangiomas, whereas capillary variant was reported in four out of 18 cases (22%) …”

“…Considering all the reported cases of hemangiomas and IPEH of the petrous bone and the clivus plus our case, 18 out of 23 cases (78%) belonged to women, whereas only five out of 23 (22%) belonged to men . Seventeen out of 20 patients (85%) were older than 17 years at diagnosis, and median age at diagnosis was 49 years. Median age at diagnosis was higher in patients with clival hemangiomas and IPEHs compared to patients with petrous bone hemangiomas and IPEHs, 61 and 42 years, respectively.…”

“…The most common features described on CT in clival and petrous bone hemangiomas and IPEHs were lytic, erosive or destructive lesions, and/or enlargement with or without bony trabeculae and honeycomb pattern . These features have been described frequently in intraosseous hemangiomas of other locations .…”

“…Seventeen out of 20 patients (85%) were older than 17 years at diagnosis, and median age at diagnosis was 49 years. Median age at diagnosis was higher in patients with clival hemangiomas and IPEHs compared to patients with petrous bone hemangiomas and IPEHs, 61 and 42 years, respectively. Symptoms were different in clival hemangiomas and petrous bone hemangiomas.…”

“…Hemangiomas of cranial bones were not detected on the initial imaging studies in some reports . Angiography studies were useful to determine the vascular nature of the lesion in some cases reported but not in other reports …”