Clivus Hemangioma
Primary intraosseous hemangiomas are benign, vascular malformations that account for approximately 1% of all primary bone neoplasms. These tumors are mostly found in the vertebral body and are rarely seen in the calvarium, where they represent 0.2% of bony neoplasms. When found in the skull, they tend to present with vague symptoms and do not have the typical radiological findings suggestive of hemangiomas. Because of this, these tumors can be missed in many cases or may be misinterpreted as more ominous lesions like multiple myeloma or osteosarcoma. Involvement of the skull base is exceedingly rare, and presentation with cranial nerve unilateral polyneuropathies has been reported 1).
Iaconis Campbell et al., treated an 11-year-old male patient with a rare case of a capillary hemangioma located in the clivus bone. The patient underwent two endoscopic endonasal resection due to tumor recurrence. Surgical safety margins are highly recommended but this procedure could not be performed due to the tumor's location. After the second relapse, the oncology team decided to initiate radiotherapy. At 6-month follow-up, the tumor reduced its size and remained unchanged.
Surgical safety margins are highly important to prevent recurrence in this type of bone tumors. Skull base hemangiomas are a big challenge when you want to achieve these safety margins. They believe that a combined treatment of surgery and radiotherapy should be considered as the main treatment 2).
In 1991 Tashiro et al., published a cavernous hemangioma of the clivus and review of the literature 3).