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Clivus chordoma associated with a pontine arachnoid cyst
Clinical Picture
Clivus chordoma associated with a pontine arachnoid cyst Francesco Doglietto, Giovanni Sabatino, Roberto Pallini Lancet Oncol 2005; 6: 536 Institute of Neurosurgery, Catholic University, Rome, Italy (F Doglietto MD, G Sabatino MD, R Pallini MD) Correspondence to: Dr Giovanni Sabatino, Institute of Neurosurgery, Catholic University, L go A Gemelli, 8, 00168 Rome, Italy [email protected]
A 30-year-old man presented with gradually worsening gait disturbances. Neurological examination showed an ataxic gait associated with mild paraparesis; the legs were hyper-reflexive, with a Babinski sign on the left leg. The patient underwent a spine MRI, which did not show any pathological abnormalities. After a few days he developed dysmetria in his left side and vertigo. Cranial MRI showed a tumour in the middle clivus (arrow, figure) and a contiguous cyst (asterisk, figure) that was compressing and dislocating the pons, both of which were hypointense in T1-weighted images. A transsphenoidal approach was used to excise the lesion that eroded the dural membrane ventral to the pons. An arachnoid cyst was found dorsally to the tumour and excised. Histological examination showed a typical chordoma. Postoperative MRI showed that the tumour had been removed completely and the cystic lesion had disappeared. After surgery, the patient had a transient worsening of paraparesis, which had improved substantially by the 9-month follow up. We postulate that the tumour, after eroding the dura, created a local flow alteration to the cerebrospinal fluid and formation of the cystic lesion. The unusual clinical presentation was probably a result of the arachnoid cyst compressing and dislocating the pons, rather than the chordoma, which commonly presents with a palsy of the sixth nerve.
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Conflict of interest We declare no conflicts of interest.
536
http://oncology.thelancet.com Vol 6 July 2005
Clivus chordoma associated with a pontine arachnoid cyst Francesco Doglietto, Giovanni Sabatino, Roberto Pallini Lancet Oncol 2005; 6: 536 Institute of Neurosurgery, Catholic University, Rome, Italy (F Doglietto MD, G Sabatino MD, R Pallini MD) Correspondence to: Dr Giovanni Sabatino, Institute of Neurosurgery, Catholic University, L go A Gemelli, 8, 00168 Rome, Italy [email protected]
A 30-year-old man presented with gradually worsening gait disturbances. Neurological examination showed an ataxic gait associated with mild paraparesis; the legs were hyper-reflexive, with a Babinski sign on the left leg. The patient underwent a spine MRI, which did not show any pathological abnormalities. After a few days he developed dysmetria in his left side and vertigo. Cranial MRI showed a tumour in the middle clivus (arrow, figure) and a contiguous cyst (asterisk, figure) that was compressing and dislocating the pons, both of which were hypointense in T1-weighted images. A transsphenoidal approach was used to excise the lesion that eroded the dural membrane ventral to the pons. An arachnoid cyst was found dorsally to the tumour and excised. Histological examination showed a typical chordoma. Postoperative MRI showed that the tumour had been removed completely and the cystic lesion had disappeared. After surgery, the patient had a transient worsening of paraparesis, which had improved substantially by the 9-month follow up. We postulate that the tumour, after eroding the dura, created a local flow alteration to the cerebrospinal fluid and formation of the cystic lesion. The unusual clinical presentation was probably a result of the arachnoid cyst compressing and dislocating the pons, rather than the chordoma, which commonly presents with a palsy of the sixth nerve.
*
Conflict of interest We declare no conflicts of interest.
536
http://oncology.thelancet.com Vol 6 July 2005