ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P136

Tumors of the clivus: various entities requiring different therapies

Jörg Flitsch1, Jakob Matschke2 & Dieter K Lüdecke1

1Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 2Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Introduction: Besides an incidental finding on MRI, headache, cranial nerve palsy, or pituitary insufficiency may lead to the diagnosis of a clivus tumor. Hormone secreting pituitary adenomas mimicking a clivus tumor can be easily identified by hormone testing, however, have to be considered prior to surgical procedures.

Methods: Within the last 3 years, 9 patients were transferred to us with the diagnosis of a clivus tumor for surgical therapy.

Results: Clinically, headaches led to initial MR imaging in 7 cases, 2 patients presented with VI nerve palsy. Two patients were diagnosed with prolactinomas prior to surgery, one patient had a mucocele of the sphenoid sinus with erosion of the clivus, another patient was diagnosed with a chondrosarcoma. In one patient a fibrous dysplasia of the clivus was found, 4 patients suffered from clivus chordomas. The prolactinoma patients were managed with dopamine agonists, all other patients were operated on via the transsphenoidal route, leading to complete resection of the mucocele and partial removal of the other entities. In cases of chondrosarcoma and chordoma, a proton beam radiotherapy was recommened.

Conclusion: In every patient, a careful exclusion of a prolactinoma is mandatory prior to a surgical intervention. The authors also recommend a preoperative CT study in osteolytic skull base tumors to exclude a (although rare) fibrous dysplasia. Depending on histology, a proton beam radiotherapy has to be considered in cases of chordomas, chondromas, or chondrosarcomas.

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