Download PDF
J Neurol Surg B Skull Base 2013; 74(05): 292-299
DOI: 10.1055/s-0033-1348027
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Metastatic Disease to the Clivus Mimicking Clival Chordomas

Adam S. DeConde
1   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
,
Yas Sanaiha
1   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
,
Jeffrey D. Suh
1   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
,
Sunita Bhuta
2   Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
,
Marvin Bergsneider
3   Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
,
Marilene B. Wang
1   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
› Author Affiliations
Further Information

Publication History

21 February 2013

15 April 2013

Publication Date:
26 June 2013 (online)

Also available at
    Permissions and Reprints

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

Note

This study was presented as a poster presentation at the North American Skull Base Society Annual Meeting, February 17 to 19, 2012, Las Vegas, NV.


 

  • References

  • 1 Korten AG, ter Berg HJ, Spincemaille GH, van der Laan RT, Van de Wel AM. Intracranial chondrosarcoma: review of the literature and report of 15 cases. J Neurol Neurosurg Psychiatry 1998; 65 (1) 88-92
    CrossrefPubMedGoogle Scholar
  • 2 Samii A, Gerganov VM, Herold C , et al. Chordomas of the skull base: surgical management and outcome. J Neurosurg 2007; 107 (2) 319-324
    CrossrefPubMedGoogle Scholar
  • 3 Pallini R, Sabatino G, Doglietto F, Lauretti L, Fernandez E, Maira G. Clivus metastases: report of seven patients and literature review. Acta Neurochir (Wien) 2009; 151 (4) 291-296 , discussion 296
    CrossrefPubMedGoogle Scholar
  • 4 Alessi G, Lemmerling M, Vereecken L, De Waele L. Benign metastasizing leiomyoma to skull base and spine: a report of two cases. Clin Neurol Neurosurg 2003; 105 (3) 170-174
    CrossrefPubMedGoogle Scholar
  • 5 Altman KW, Mirza N, Philippe L. Metastatic follicular thyroid carcinoma to the paranasal sinuses: a case report and review. J Laryngol Otol 1997; 111 (7) 647-651
    PubMedGoogle Scholar
  • 6 Baeg MK, Bae SH, Lee KH, Kim J, Park IS, Jin JY. Diplopia as a presenting symptom in a gastric gastrointestinal stromal tumor. Jpn J Clin Oncol 2011; 41 (2) 265-268
    CrossrefPubMedGoogle Scholar
  • 7 Barrière J, Thariat J, Vandenbos F, Bondiau PY, Peyrottes I, Peyrade F. Diplopia as the first symptom of an aggressive metastatic rectal stromal tumor. Onkologie 2009; 32 (6) 345-347
    CrossrefPubMedGoogle Scholar
  • 8 Bohnstedt BN, Tomcik M, Eads T, Hagen MC, Shah M. Metastasis of soft-tissue myoepithelial carcinoma to clivus. J Neurosurg Pediatr 2012; 9 (2) 161-164
    CrossrefPubMedGoogle Scholar
  • 9 Casals MM, Hunter SB, Olson JJ, Gussack G, Blevins Jr LS. Metastatic follicular thyroid carcinoma masquerading as a chordoma. Thyroid 1995; 5 (3) 217-221
    PubMedGoogle Scholar
  • 10 Endo K, Okano R, Kuroda Y, Yamada S, Tabei K. Renal cell carcinoma with skull base metastasis preceded by paraneoplastic signs in a chronic hemodialysis patient. Intern Med 2001; 40 (9) 924-930
    CrossrefPubMedGoogle Scholar
  • 11 Escott EJ. A variety of appearances of malignant melanoma in the head: a review. Radiographics 2001; 21 (3) 625-639
    PubMedGoogle Scholar
  • 12 Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurgery 2010; 67 (3, Suppl Operative): ons150-ons158 , discussion ons158
    CrossrefPubMedGoogle Scholar
  • 13 Fukushima M, Katayama Y, Shigemori Y, Miyake H, Hirayama T, Kotani A. Clivus metastasis from gastric signet ring cell carcinoma after a 10-year disease-free interval—case report. Neurol Med Chir (Tokyo) 2012; 52 (10) 751-753
    CrossrefPubMedGoogle Scholar
  • 14 Greenberg HS, Deck MD, Vikram B, Chu FC, Posner JB. Metastasis to the base of the skull: clinical findings in 43 patients. Neurology 1981; 31 (5) 530-537
    CrossrefPubMedGoogle Scholar
  • 15 Hirai O, Kikuchi H, Hashimoto N. Skull base metastasis from gastric cancer—case report. Neurol Med Chir (Tokyo) 1992; 32 (12) 908-910
    CrossrefPubMedGoogle Scholar
  • 16 Isaka T, Maruno M, Suzuki T, Sato M, Yoshimine T. Skull metastases from atypical pulmonary carcinoid tumor in a 19-year-old man. Neurol Med Chir (Tokyo) 2006; 46 (12) 609-613
    CrossrefPubMedGoogle Scholar
  • 17 Kelley TF, Stankiewicz JA, Chow JM, Origitano TC. Endoscopic transsphenoidal biopsy of the sphenoid and clival mass. Am J Rhinol 1999; 13 (1) 17-21
    CrossrefPubMedGoogle Scholar
  • 18 Kim M, Na DL, Park SH, Jeon BS, Roh JK. Nervous system involvement by metastatic hepatocellular carcinoma. J Neurooncol 1998; 36 (1) 85-90
    CrossrefPubMedGoogle Scholar
  • 19 Kim SR, Kanda F, Kobessho H , et al. Hepatocellular carcinoma metastasizing to the skull base involving multiple cranial nerves. World J Gastroenterol 2006; 12 (41) 6727-6729
    PubMedGoogle Scholar
  • 20 Kingdom TT, Delgaudio JM. Endoscopic approach to lesions of the sphenoid sinus, orbital apex, and clivus. Am J Otolaryngol 2003; 24 (5) 317-322
    CrossrefPubMedGoogle Scholar
  • 21 Kocak Z, Celik Y, Uzal MC, Uygun K, Kaya M, Albayram S. Isolated bilateral sixth nerve palsy secondary to metastatic carcinoma: a case report with a review of the literature. Clin Neurol Neurosurg 2003; 106 (1) 51-54
    CrossrefPubMedGoogle Scholar
  • 22 Kolias AG, Derham C, Mankad K , et al. Multiple cranial neuropathy as the initial presentation of metastatic prostate adenocarcinoma: case report and review of literature. Acta Neurochir (Wien) 2010; 152 (7) 1251-1255
    CrossrefPubMedGoogle Scholar
  • 23 Malloy KA. Prostate cancer metastasis to clivus causing cranial nerve VI palsy. Optometry 2007; 78 (2) 55-62
    CrossrefPubMedGoogle Scholar
  • 24 Marchese-Ragona R, Maria Ferraro S, Marioni G , et al. Abducent nerve paralysis: first clinical sign of clivus metastasis from tonsillar carcinoma. Acta Otolaryngol 2008; 128 (6) 713-716
    CrossrefPubMedGoogle Scholar
  • 25 McDermott RS, Anderson PR, Greenberg RE, Milestone BN, Hudes GR. Cranial nerve deficits in patients with metastatic prostate carcinoma: clinical features and treatment outcomes. Cancer 2004; 101 (7) 1639-1643
    CrossrefPubMedGoogle Scholar
  • 26 McGirt MJ, Cowan Jr JA, Gala V, Garton HJ, Muraszko KM, Thompson BG. Surgical reversal of prolonged blindness from a metastatic neuroblastoma. Childs Nerv Syst 2005; 21 (7) 583-586
    CrossrefPubMedGoogle Scholar
  • 27 Ng EST, Tan S-H, Ling WHY, Venkatesh SK, Wong C-I. Ophthalmoplegia in a patient with breast cancer. Ann Acad Med Singapore 2011; 40 (11) 507-509
    PubMedGoogle Scholar
  • 28 Nozaki I, Tsukada T, Nakamura Y, Takanaka T, Yamada M. Multiple skull metastases from hepatocellular carcinoma successfully treated with radiotherapy. Intern Med 2010; 49 (23) 2631-2634
    CrossrefPubMedGoogle Scholar
  • 29 O'Boyle JE, Gardner TA, Oliva A, Enzenauer RW. Sixth nerve palsy as the initial presenting sign of metastatic prostate cancer. A case report and review of the literature. J Clin Neuroophthalmol 1992; 12 (3) 149-153
    PubMedGoogle Scholar
  • 30 Rosahl SK, Erpenbeck V, Vorkapic P, Samii M. Solitary follicular thyroid carcinoma of the skull base and its differentiation from ectopic adenoma—review, use of galectin-3 and report of a new case. Clin Neurol Neurosurg 2000; 102 (3) 149-155
    CrossrefPubMedGoogle Scholar
  • 31 Ruchti C, Balli-Antunes M, Gerber HA. Follicular tumor in the sellar region without primary cancer of the thyroid. Heterotopic carcinoma?. Am J Clin Pathol 1987; 87 (6) 776-780
    PubMedGoogle Scholar
  • 32 Salas E, Sekhar LN, Ziyal IM, Caputy AJ, Wright DC. Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients. J Neurosurg 1999; 90 (2, Suppl) 206-219
    PubMedGoogle Scholar
  • 33 Santarpia L, Gagel RF, Sherman SI, Sarlis NJ, Evans DB, Hoff AO. Diabetes insipidus and panhypopituitarism due to intrasellar metastasis from medullary thyroid cancer. Head Neck 2009; 31 (3) 419-423
    CrossrefPubMedGoogle Scholar
  • 34 Anon. PubMed Link. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18798312 . Accessed January 14, 2013.
    PubMedGoogle Scholar
  • 35 Sim RS, Tan HK. A case of metastatic hepatocellular carcinoma of the sphenoid sinus. J Laryngol Otol 1994; 108 (6) 503-504
    PubMedGoogle Scholar
  • 36 Turner JL, Sweeney P, Hardy R. Ewing's tumor metastatic to the clivus, simulating meningitis: case report. Neurosurgery 1980; 7 (6) 619-620
    CrossrefPubMedGoogle Scholar
  • 37 Ulubaş B, Özcan C, Acka G, Aydn O, Saritaş E. Clivus metastasis of squamous cell carcinoma: a rare location. J Clin Neurosci 2005; 12 (1) 97-98
    CrossrefPubMedGoogle Scholar
  • 38 Maccauro G, Spinelli MS, Mauro S, Perisano C, Graci C, Rosa MA. Physiopathology of spine metastasis. Int J Surg Oncol 2011; 2011: 1-8
    PubMedGoogle Scholar
  • 39 Coman DR, deLONG RP. The role of the vertebral venous system in the metastasis of cancer to the spinal column; experiments with tumor-cell suspensions in rats and rabbits. Cancer 1951; 4 (3) 610-618
    CrossrefPubMedGoogle Scholar
  • 40 Zhang J, Stringer MD. Ophthalmic and facial veins are not valveless. Clin Experiment Ophthalmol 2010; 38 (5) 502-510
    CrossrefPubMedGoogle Scholar
  • 41 Gangadhar K, Santhosh D. Radiopathological evaluation of primary malignant skull tumors: a review. Clin Neurol Neurosurg 2012; 114 (7) 833-839
    CrossrefPubMedGoogle Scholar
  • 42 Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol 2012; 13 (2) e69-e76
    CrossrefPubMedGoogle Scholar
  • 43 Fogelman I, Cook G, Israel O, Van der Wall H. Positron emission tomography and bone metastases. Semin Nucl Med 2005; 35 (2) 135-142
    CrossrefPubMedGoogle Scholar
  • 44 Baratti D, Gronchi A, Pennacchioli E , et al. Chordoma: natural history and results in 28 patients treated at a single institution. Ann Surg Oncol 2003; 10 (3) 291-296
    CrossrefPubMedGoogle Scholar
  • 45 Umansky F, Valarezo A, Elidan J. The microsurgical anatomy of the abducens nerve in its intracranial course. Laryngoscope 1992; 102 (11) 1285-1292
    CrossrefPubMedGoogle Scholar
  • 46 Volpe NJ, Liebsch NJ, Munzenrider JE, Lessell S. Neuro-ophthalmologic findings in chordoma and chondrosarcoma of the skull base. Am J Ophthalmol 1993; 115 (1) 97-104
    PubMedGoogle Scholar
  • 47 McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM. Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control 2001; 12 (1) 1-11
    CrossrefPubMedGoogle Scholar
  • 48 Brackmann DE, Teufert KB. Chondrosarcoma of the skull base: long-term follow-up. Otol Neurotol 2006; 27 (7) 981-991
    CrossrefPubMedGoogle Scholar