A Rare Case of Clival Paraganglioma

A woman in her fourth decade presented with 1 month of dysphagia, hoarseness, diplopia, and right hemifacial hypoesthesia. Examination was notable for normal facial movement, normal hearing on audiogram, and bilateral vocal cord mobilility. MRI brain demonstrated an avidly enhancing lesion thought to be a clival meningioma ([Fig. 1]). She underwent a left combined transpetrosal craniotomy for resection of the tumor by neurosurgery and neurotology ([Fig. 2]). Postoperatively, she awoke with a left House–Brackmann grade II facial nerve palsy, CN VI palsy, and diminished sensation in the left V1 and V2 distribution. MRI brain demonstrated small volume residual tumor along the left petroclival junction ([Fig. 3]). Pathologic examination revealed paraganglioma ([Fig. 4]). She required temporary tracheostomy and gastrostomy tube which were removed prior to discharge. Postoperative radiation therapy for the residual tumor is planned.

Paragangliomas (PGL) are uncommon benign neuroendocrine tumors of the parasympathetic nervous system, most frequently arising from the adrenal medulla. Head and neck lesions account for 5% of all PGLs and skull base PGLs are even rarer. This case illustrates the clinical, radiographic, and histopathologic features of a very rare PGL mimicking meningioma. We discuss the management options, including surgical approach and radiation therapy.

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Publication History

Article published online:
15 February 2022