PMC8035581_01
Computed tomography images of the illustrative case. (a-c) Preoperative nonenhanced bony computed tomography revealing calcification including an osteolytic lesion. Coronal view revealing a lytic lesion that occupied the condyle and C1 lateral mass. Sagittal view showing the lytic lesion which extends to the upper clivus
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Computed tomography (CT) revealed a calcification of mass lesion with osteolytic changes in the clivus [Figure 1a-c].
Preoperative magnetic resonance images revealing that the lesion had low intensity on T1- and T2-weighted images. The lesion is enhanced heterogeneously by gadolinium administration. (a) T1-weighted image, (b) T2-weighted image, (c) gadolinium-enhanced image
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Magnetic resonance imaging showed that the lesion had relatively low intensity in both T1- and T2-weighted images and was heterogeneously enhanced by gadolinium [Figure 2a-c].
Intraoperative photographs of the illustrative case. An endoscopic endonasal transclival approach is performed to confirm the pathological finding and to decompress the left lower cranial nerves. (a) The lesion below the sellae turcica is exposed. The lesion is hemorrhagic and white-yellow in color, and consists of relatively soft tissue. (b) The lateral side of the lesion is resected until the bilateral internal carotid arteries are exposed. (c) The upper side of the lesion near the dorsum sellae is drilled out. (d) Near the left lateral side of the lesion, the left hypoglossal canal is opened
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Intraoperatively, the lesion was hemorrhagic and white-yellow in color, and consisted of relatively soft tissue [Figure 3a]. The lateral side of the lesion was resected until the C5 portion of the medial side of the internal carotid artery was exposed [Figure 3b]. The upper side of the lesion was resected until normal dura and bone were exposed [Figure 3c]. On the left inferior lateral side, the left hypoglossal canal was opened [Figure 3d].
Postoperative nonenhanced bony computed tomography images of the illustrative case: (a-c) The lesion is resected between the dorsum sellae and lower clivus without the condyle joint
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Postoperative imaging findings showed that the lesion was resected between the dorsum sellae and lower clivus without the condyle joint [Figure 4].
Pathological findings (H and E): (a) Multinucleated giant cells surrounding the focal hemorrhage are seen. (x100) (b) Abundant spindle-shaped fibroblast cells and multinucleated giant cells are present ( x200)
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The final diagnosis was a GCRG [Figure 5].