Primary intraosseous cavernous hemangioma of the clivus in a pediatric patient: A case report and review of the literature

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Background: Primary intraosseous cavernous hemangiomas (PICH) of the skull are rare, benign, vascular tumors mainly found in adults' calvarium. Affection of the clivus has been reported, with the most frequent clinical presentation being headaches followed by cranial nerve compromise. In the pediatric population, it has only been described once and was treated with surgery and radiation. Case Description: A 14-year-old previously healthy female presented with episodes of right lingual fasciculations. The investigation of these signs with brain magnetic resonance imaging (MRI) revealed a large clival contrast-enhancing lesion. The patient underwent an endoscopic endonasal biopsy. The histologic findings were consistent with the diagnosis of cavernous hemangioma. She started treatment with propranolol, with serial MRIs showing lesion stability. The last follow-up MRI, 4 years after diagnosis, revealed a mild decrease in the volume of the lesion, and she remains asymptomatic. Conclusion: We report the first clival PICH in a pediatric patient, managed without surgery and radiotherapy and treated with propranolol. We present neuro-imaging findings at diagnosis and during follow-up and a brief review of the literature on the topic.

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