- Intern, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Department of Neurosurgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia.
- Department of Neurosurgery, King Saud University Medical City, Riyadh, Saudi Arabia.
Jumana Abdulmohsen Fatani
Department of Neurosurgery, King Saud University Medical City, Riyadh, Saudi Arabia.
DOI:10.25259/SNI_478_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Jumana Abdulmohsen Fatani1, Alaa Arab2, Hisham Alkhalidi3, Abdulrazag Ajlan4. Clival simple bone cyst: Rare pathological entity (case report). 11-Dec-2020;11:427
How to cite this URL: Jumana Abdulmohsen Fatani1, Alaa Arab2, Hisham Alkhalidi3, Abdulrazag Ajlan4. Clival simple bone cyst: Rare pathological entity (case report). 11-Dec-2020;11:427. Available from: https://surgicalneurologyint.com/surgicalint-articles/10449/
Background: Clival cystic lesions are not frequently seen in neurosurgery. Cystic lesion in the clivus can be part of a neoplastic process such as chordoma, chondrosarcoma, plasmacytoma, or metastasis. Rare types of pure cystic clival lesions include simple bone cysts and arachnoid cysts, which are asymptomatic most of the time and do not cause symptoms until they reach a large size.
Case Description: This is a case report of a healthy 53-year-old male patient with a clival cystic lesion. The patient underwent surgical drainage and wall resection of the clival lesion with no postoperative complications. Intraoperative finding raised the possibility of the diagnosis of an arachnoid cyst. However, the pathology findings indicated a simple bone cyst.
Conclusion: Simple bone cyst and arachnoid cyst in the clivus are rare, they should be considered in the diagnosis of clival cystic lesions.
Keywords: Arachnoid, Clivus, Simple cyst
Clival lesions are not uncommonly encountered in neurosurgery. Cystic lesion in the clivus can be part of a neoplastic process such as chordoma, chondrosarcoma, plasmacytoma, or metastasis.[
History and examination
This is a healthy 53-year-old male with an unremarkable medical or surgical history, who has a 6-month history of progressive neck pain that radiates to his right and left shoulders. The patients’ pain, which was alleviated by analgesia and physiotherapy, increased when he lay flat or on his left side. His neurological examination, including a cranial nerves exam, indicated normal findings. There was no history of trauma or sinus disease.
Imaging of the cervical spine and brain was performed. The brain magnetic resonance imaging (MRI) [
(a) Computed tomography (CT) scan, sagittal view, bone window showing the clival cyst (b) CT scan, sagittal view showing the clival cyst communicating with subarachnoid space (c) CT scan, bone window showing the clival cyst (arrow) (d) CT scan, bone window showing the clival cyst communicating with arachnoid space (e) magnetic resonance imaging (MRI), T2 sequence, axial cut (f) MRI, T1 sequence, axial view with contrast. (G) MRI, T1 sequence, sagittal view with contrast (h) MRI, T1 sequence, sagittal view (i) MRI, diffusion-weighted imaging sequence, axial view showing no restriction (j) MRI, T2 sequence, axial cut showing the clival cyst (k) MRI, T2 sequence, axial cut showing the cyst communicating with subarachnoid space (l) MRI, T2 sequence, sagittal cut showing the clival cyst communicating with subarachnoid space (m and n) Postoperative imaging post cyst drainage and cystic wall resection, the cystic cavity filled with fat graft (o) Intraoperative view of the endoscopic transnasal approach showing the cystic cavity in the clival cyst after anterior wall opening (p) Intraoperative view showing the cystic wall.
The patient underwent transnasal endoscopic resection of the clival lesion in collaboration with the ear, nose, and throat team using neuronavigation. The superior margin of the clival lesion was identified by neuronavigation, and then trepination of the anterior portion of the clivus was performed using a high-speed drill [
The specimens taken from the bone, cyst wall, and cavity consisted of a fragmented white tan hemorrhagic bony and soft tissue. Microscopy [
Simple bone cysts are benign lesions that can affect nearly any bone;[
On the other hand, arachnoid cyst is a developmental collection of cerebrospinal fluid (CSF) within the arachnoid membranes. Most of the time, these cysts are detected incidentally, but they may expand progressively and cause symptoms by increasing the intracranial pressure or compressing nearby neural structures.[
The final diagnosis of our lesion was simple clival bone cyst. Only one case of a clival simple cyst has been reported.[
In pure clival cysts, surgical intervention is not recommended and should be only performed in progressive symptomatic cysts or when the diagnosis is really in doubt.
We report a case of a clival cyst that underwent successful surgical resection and evacuation of the clival lesion.
Because simple bone cyst and arachnoid cyst in the clivus are rare, they should be considered in the diagnosis of clival cystic lesions.
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