PMC6739702_01
Preoperative MRI and CT scan. a, b Preoperative T2-weighted sagittal and T1-weighted postgadolinium axial images demonstrating a large homogeneous tumor arising from the clivus and extending both toward the left cavernous sinus and toward the CCJ with contrast enhancement. c, d Preoperative sagittal and axial CT scan confirmed lytic bone destruction of occipital condyles, C1, and C2.
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F1
An MRI scan of the brain revealed a large inhomogeneous tumor arising from the clivus and extending both toward the left cavernous sinus and toward the CCJ with contrast enhancement (Fig. 1a, b). The CT scan confirmed lytic bone destruction of occipital condyles, C1, and C2 (Fig. 1c, d).
a, b Intraoperative images during the endoscopic endonasal approach demonstrating the lesions at the level of the clivus and the left cavernous sinus and the removal of the tumor for tissue sampling and decompression of the VI cranial nerve at the level of Dorello's canal. c, d Postoperative MRI showing partial resection of the tumor with decompression of the left paraclival/cavernous sinus region along the course of the VI cranial nerve. e Postoperative CT scan with 3D reconstruction revealing the approach at the level of the clivus extended to the left carotid canal. f X-rays after occipitocervical fixation and fusion.
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F2
Due to the progressive VI cranial nerve palsy, the patient first underwent an extended endoscopic endonasal approach (EEA) both to sample tissue for diagnosis and to decompress the VI cranial nerve (Fig. 2a-e) under neuronavigation guidance, as already described in previous papers. The postoperative course was uneventful as well, and postoperative X-rays and CT scan demonstrated realignment of CCJ elements and right positioning of screws/plate and rods (Fig. 2f).
Histological examination consistent with metastatic urothelial carcinoma. a Solid nests of carcinoma cells are present in a desmoplastic stroma. The neoplastic cells do not show any morphological differentiation (HE, 100x total magnification). b, c By immunohistochemistry, the carcinoma cells are positive for GATA3 (b) and uroplakin III (c), demonstrating an urothelial origin of carcinoma.
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F3
Histological examination was consistent with metastatic urothelial carcinoma (Fig. 3a-c).