EOSINOPHILIC GRANULOMA OF THE CLIVUS - CASE-REPORT, FOLLOW-UP OF 2 PREVIOUSLY REPORTED CASES, AND REVIEW OF THE LITERATURE ON CRANIAL BASE EOSINOPHILIC GRANULOMA

OBJECTIVE AND IMPORTANCE: To our knowledge, this is the first reported case of the use of stereotactic radiotherapy for an eosinophilic gran uloma (EC) of the clivus. We report follow-up information on two previ ously reported cases and suggest a management plan for this rare lesio n. CLINICAL PRESENTATION: We report the case of a 4.5-year-old boy who presented with a complete abducens palsy on the right with an associa ted head turn. A computed tomographic scan of his head revealed a lyti c lesion on that side, and magnetic resonance imaging showed the mass to be of low intensity on T1-weighted images and of high intensity on T2-weighted images with heterogeneous enhancement. INTERVENTION: A tra nsnasal stereotactic biopsy was performed, revealing an EG. The patien t was treated with stereotactic radiotherapy, and he became symptom-fr ee with radiographic resolution of his lesion. Reviewing the literatur e, we found 13 series with 87 cases of EG in the petrous portion of th e temporal bone. EG in the cranial base occurring outside of the tempo ral bone or in the temporal bone and extending intracranially is, howe ver, quite rare, with only nine other cases reported, two of them cliv al. CONCLUSION: These findings suggest a classification schema in whic h cranial base EG lesions be grouped with either the more common extra cranial petrous temporal bone lesions or the very rare intracranial le sions. Although there are few cases in the literature, treatment resul ts indicate that clival EC, and perhaps all intracranial cranial base EGs, be treated by a biopsy alone, followed by surgery or stereotactic radiotherapy if there is an incomplete resolution of the symptoms or if there is a recurrence.