Non-Chordomatous Clival Lesions

Solitary lesions of the clivus represent rare pathologies with peculiar natural courses and treatment modalities. Chordomas constitute the majority of cases, while solitary non-chordomatous clival (NCC) lesions are notably less frequent. Among NCC lesions, chondrosarcomas emerge as the most prevalent histological subtype, followed by solid metastases, fibrous dysplasia, and a spectrum of other rare entities such as ectopic adenomas, lymphomas, solitary plasmacytomas, and giant cell tumors. Diplopia secondary to sixth nerve palsy and headache are common presenting symptoms, with larger lesions potentially causing cranial nerve involvement and brainstem compression. In this chapter, we summarized the available literature on the most encountered NCC histological entities affecting the clivus. It includes an analysis of 156 original papers, comprising data from 754 patients. The following paragraphs comprehensively cover the epidemiology, natural history, pathology, clinical and radiological features, as well as therapeutic approaches to these challenging lesions, and offer a foundation for informed clinical decision-making and optimal patient care within the confines of available literature. Pathologies are discussed in descending order of frequency.