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Solitary lesions of the clivus: what else besides chordomas? An extensive clinical outlook on rare pathologies

  • Clinical Article - Brain Tumors
  • Published:
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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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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy

    Filippo Gagliardi, Alfio Spina, Nicola Boari & Pietro Mortini

  2. Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Scientific Institute, Milan, Italy

    Ashwin Narayanan

Authors
  1. Filippo Gagliardi
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  2. Alfio Spina
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  3. Nicola Boari
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  4. Ashwin Narayanan
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  5. Pietro Mortini
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Corresponding author

Correspondence to Filippo Gagliardi.

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Comment

This case series reminds us of the differential diagnosis of clival lesions; surprisingly, 30 % of patients in this series harboured non-chordomatous lesions. This further emphasises the need for at least tissue diagnosis on clival lesions (whether symptomatic or asymptomatic) because of the significant heterogeneity of lesions in this location with differences in the natural history, treatment, and outcome. However, when the radiological features are typical of clival ecchondrosis, a biopsy is not indicated.

Amir Dehdashti

NY, USA

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Gagliardi, F., Spina, A., Boari, N. et al. Solitary lesions of the clivus: what else besides chordomas? An extensive clinical outlook on rare pathologies. Acta Neurochir 157, 597–605 (2015). https://doi.org/10.1007/s00701-014-2340-1

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  • DOI: https://doi.org/10.1007/s00701-014-2340-1

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