Intraosseous venous malformation of the clivus

This case report presents a female patient in her teens who experienced a 1-month history of intermittent right-sided tongue numbness and twitching.Investigations included laboratory tests and an electroencephalogram, both of which were unremarkable. A brain MRI revealed an expansile mass occupying the entirety of the clivus and the condylar segment of the right occipital bone. A CT scan further demonstrated an osteolytic and expansile mass within the clivus, with multiple areas of thickened bone trabeculae resembling a 'honeycomb pattern'. A trans-sphenoidal surgical biopsy disclosed an intraosseous venous malformation (cavernous type, formerly known as primary intraosseous cavernous haemangioma).At the neuropaediatric multidisciplinary meeting, curative intent in the form of complete surgical resection was deemed difficult to achieve and it was decided to initiate empirical propranolol therapy. After 2 years of treatment, the patient became asymptomatic and the lesion slightly reduced in size. The following year, the lesion remained stable.