Clival aneurysmal bone cyst

Case contributed by Mohamed Mahmoud Elthokapy
Diagnosis probable


Progressive headache and diplopia with bi-temporal hemianopia on ophthalmological examination.

Patient Data

Age: 25 years
Gender: Male

A well-defined midline SOL centered upon the clivus (basi-occiput and basisphenoid) is seen measuring 4.6x3.6x3.8 cm in maximal AP, TV, and CC dimensions respectively. The lesion displays a non-homogenous low T1 with foci of high T1 (?? Hemorrhagic foci) and bright T2 and high FLAIR signal intensity showing multiple air-fluid levels, with marginal and septal enhancement after post-contrast series.

Superiorly, the lesion partially obliterates the supra-sellar cistern and displacing the dorsum sellae and minimally attenuating the infundibular recess of the third ventricle while inferiorly; reaching to the lower part of basi-occipit and basi-sphneoid bones. On either side, the lesion abuts both internal carotid arteries , that appear patent, judged by their signal void character. Posteriorly, It attenuate the prepontine cistern, anteriorly the mass fills the sphenoid sinus.

Normal size, shape and position of the ventricular system No evidence of hydrocephalus or brain atrophy.

Normal pituitary gland that appears compressed upward.

Case Discussion

This case describes clival/sphenoidal mass lesion showing predominantly cystic compartments with multiple fluid levels as well as septal and marginal enhancement after post-contrast series

The differential diagnoses considered are as follows (in a descending manner):

  1. aneurysmal bone cyst

  2. chordoma

  3. giant cell tumor (GCT)

  4. eosinophilic granuloma

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