Transsphenoidal Removal of Recurrent Osteoid Osteoma of Clivus

An osteoid osteoma (OO) is a benign bone neoplasm that typically occurs in the long bone diaphysis. We found only 8 cases of OOs of the skull base in the literature, and none of them were located in the clivus.

A 44-year-old female patient with a history of 2 previous transsphenoidal surgeries with partial removal of an OO of the clivus at another hospital, 11 and 4 years ago, presented to our department with recurrent progressive left-sided headache and facial pain over the past 6 months, which were aggravated at night. A new computed tomography (CT) scan of the head revealed a low-density, well-demarcated area surrounded by a high-density sclerotic bone in the clivus. A total transsphenoidal microscopic removal of the lesion was performed with the use of intraoperative neuronavigation. The patient recovered from surgery without any new deficits, and the headache was relieved during her inpatient hospital stay. A CT scan of the head that was performed 1 day after surgery revealed the complete removal of the lesion. The patient was discharged on day 5 after surgery. A follow-up examination conducted 3 months after surgery showed that the patient still had no headache or any other symptoms. A follow-up CT scan revealed no remnant or recurrent tumor.

The transsphenoidal approach with the use of neuronavigation appears to be a good choice to achieve total removal of an OO of the upper part of the clivus in case of persistent pain and lack of sufficient effect by nonsteroidal antiinflammatory drugs.