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Updated: Sep 12, 2025

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Published on: July 5, 2021

Ectopic clival craniopharyngioma.

Golnaz Lotfian¹, Akram Al-Warqi², Santhosh Gaddikeri²

¹Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA. Lotfian.golnaz@gmail.com.

|August 7, 2025

Summary

This report details an exceptionally young patient with an ectopic clival craniopharyngioma, a rare tumor. Distinct MRI findings helped differentiate it from chordoma, offering valuable diagnostic insights.

Keywords:

Chordoma Craniopharyngioma Ectopic clival craniopharyngioma Pituitary gland tumor

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Area of Science:

Neuro-oncology
Pediatric Radiology
Pathology

Background:

Craniopharyngiomas are rare, benign tumors with bimodal age distribution, often affecting children and older adults.
These tumors arise along the craniopharyngeal tract, commonly in intra/suprasellar regions, potentially compressing adjacent structures and causing varied symptoms.
Chordomas are distinct rare tumors originating from notochordal remnants, typically in the sacrum or clivus, with characteristic imaging features.

Purpose of the Study:

To report a rare case of ectopic clival craniopharyngioma in an 11-year-old, the youngest documented.
To highlight unique imaging findings that aid in differentiating this tumor from chordoma.
To contribute to the understanding of rare craniopharyngioma presentations.

Main Methods:

Case report of an 11-year-old patient with an ectopic clival craniopharyngioma.
Diagnostic evaluation utilizing Magnetic Resonance Imaging (MRI).
Comparison of imaging characteristics with typical craniopharyngioma and chordoma presentations.

Main Results:

The patient presented with an ectopic clival craniopharyngioma extending from the sellar to the clival region.
Key imaging findings included T1 hyperintensity and a downward growth pattern along the expected Rathke pouch course.
These features were crucial in distinguishing the craniopharyngioma from a chordoma.

Conclusions:

Ectopic clival craniopharyngiomas, though rare, can occur in pediatric patients.
Specific MRI findings, such as T1 hyperintensity and growth pattern, are vital for accurate diagnosis and differentiation from other skull base tumors like chordoma.
This case underscores the importance of detailed imaging analysis in diagnosing rare pediatric neoplasms.