Applications of Endonasal Endoscopic Surgery in the Fibrous Dysplasia of the Clivus

We report two cases of patients with Fibrous Dysplasia.

Case 1: A 53-year-old female with with past medical history of hypertension with a 4-year history of headaches and tinnitus. Otolaryngologic and neurologic examination was unremarkable. Computer tomography (CT) scan revealed ground glass lesion and expansion of the clivus ventrolateral and left dorsolateral. Magnetic resonance imaging (MRI) revealed isossinal of the clivus on T1 and hypodensity em T2 imaging. Patient underwent transnasal endoscopic sphenoidotomy for diagnosis with partial removal of the component, and the anatomopathologic evidenced fibrous dysplasia. She received conservative symptomatic management. She continues to be followed clinically, she improved her headache while maintaining tinnitus.

Case 2: A 35-year-old male with no significant past medical history presents with a 6 months history of headaches. Otolaryngologic and neurologic examination was unremarkable. CT scan revealed lesion cistyc, osteolytic and expansion of the clivus lateral center. MRI revealed revealed isossinal of the clivus on T1 and hypodensity em T2 imaging. Patient underwent transnasal endoscopic sphenoidotomy for diagnosis with partial removal of the component, and the anatomopathologic evidenced fibrous dysplasia. He received conservative symptomatic management. He got headache improvement continues to be followed clinically. Little more than 20 cases of about fibrous dysplasia involving the clivus are related in the literature. The correct differential diagnosis of diseases that affect the clivus is the first step to proceed to an adequate management, since the treatment of fibrous dysplasia completely different from that of other lesions that they affect clivus. Endoscopic approaches are convenient for skull base lesions even for biopsy or curative resections providing panoramic view and avoid brain retraction. We discuss clinical aspects, image exams, histology and treatment endoscopic of this rare presentation of the disease.