Abstract
Introduction Clival tumors are rare and heterogeneous. Although some benign prototypical sellar
lesions may present as clival tumors, the likelihood of malignant disease is higher.
Here we define a novel algorithm for the workup and management of clival masses through
an illustrative case of colorectal adenocarcinoma metastasis to the clivus.
Methods In this case report, the best practice guidelines for managing clival masses are
described through a literature review and refined by senior author consensus. We conducted
a focused systematic review to characterize the present case in the context of clival
metastasis from gastrointestinal malignancy.
Results An 83-year-old woman presented with 4 weeks of headaches and blurry vision. Examination
revealed partial right abducens and left oculomotor palsies. Magnetic resonance imaging
(MRI) identified a large, weakly enhancing sellar and clival mass with sphenoid sinus
extension. An aggressive subtotal endoscopic endonasal resection was performed with
removal of all sphenoid, clival, and sellar disease without cavernous sinus wall resection.
Pathology confirmed colorectal adenocarcinoma; computed tomography (CT) imaging identified
an ascending colon mass with metastases to the liver and mesenteric nodes. Palliative
oncologic therapies were recommended, but she elected hospice, and died 3 months after
initial presentation. Gastrointestinal clival metastases are exceedingly rare among
sellar and clival pathologies, with eight prior cases reported, most of which presented
with diplopia from abducens nerve involvement.
Conclusion Clival masses are uncommon skull base lesions that are associated with more aggressive
diseases. We present a consolidated framework for decision-making in these challenging
patients, alongside an unusual case example that illustrates the importance of increased
suspicion for malignant clinical entities in this setting.
Keywords
clivus - sella - metastasis - colorectal adenocarcinoma
