PMC9280865_01
T1 postcontrast MRI demonstrating an avidly enhancing extra-axial clival tumor with brainstem compression. A, Sagittal. B, Coronal. C, Axial.
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F1
MRI brain demonstrated an avidly enhancing and T2 hyperintense retroclival mass with significant mass effect on the adjacent brainstem, cranial nerves, and vascular structures (Figure 1).
PMC9280865_02
Multiple views of angiogram demonstrating brisk filling of the tumor via anterior and posterior circulation. A, Left vertebral artery run, AP view. B, Right internal carotid artery run, lateral view.
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F2
Preoperatively, the patient underwent preoperative angiography to better delineate the tumors relationship to the posterior circulation (Figure 2).
A-C, Intraoperative findings of clival paraganglioma, including cranial nerve V, the cranial nerve VII/VIII complex, and the basilar artery with adherent tumor.
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F3
The following day, she underwent a combined left extended retrosigmoid craniotomy, temporal craniotomy, and posterior petrosectomy with neurosurgery and neuro-otology with stereotaxy, SSEP, MEP, and monitoring of cranial nerves V, VII, VIII, IX and X This approach was chosen to minimize retraction of normal cerebellum in this young patient, as well as to provide access to both the supratentorial and infratentorial compartments (Figure 3).
PMC9280865_03
Pathology demonstrating fibrous tissue consisting of nests and clusters of cells that display hyperchromatic nuclei, coarsely granular chromatin and moderate to abundant eosinophilic cytoplasm. A, H&E (40x). B, Synaptophysin stain. C, Chromogranin stain.
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F4
This pathologic profile was consistent with a paraganglioma (Figure 4).
PMC9280865_04
PMC9280865_05
A-C, Fractionated radiation treatment planning.
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F5
A discussion regarding management of residual was held with the patient and a multi-disciplinary tumor board, and the decision was made to refer to radiation oncology for fractionated conformal radiotherapy of small residual disease (Figure 5).