Abstract
Objectives/Hypothesis A comprehensive review of the literature of clival metastases and presentation of
two additional cases.
Study Design Literature review and report of two cases.
Methods A literature review of the MEDLINE database (1950 to January 19, 2013) was performed
to identify all cases of patients with metastatic disease to the clivus. Additionally,
two novel cases are presented.
Results In total, 47 cases were identified in the literature, including the two cases presented
in this study. Metastatic disease to the clivus is the initial presenting symptom
of the primary malignancy in 36% (13/36) of the cases. When there was a history of
malignancy, the median interval of time to clival metastases was 24 months (range
1 to 172 months). Clinical symptoms manifested often as cranial neuropathies, with
at least abducens palsies as the initial presenting symptom in 61.9% (26/42) of patients.
Tumor pathology was diverse, but several pathologies were seen more commonly: prostate
carcinoma (18.1%, 9/47), hepatocellular carcinoma (10.6%, 5/47), and thyroid follicular
carcinoma (8.5%, 4/47).
Conclusion Although clival metastases are extremely rare, they are an important part of the
differential of clival masses as they can be the presenting symptom of distant malignancy.
Level of Evidence 4.
Keywords
skull base - clivus - clival metastases - clival tumor - clival chordoma
