CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(02): 201-217
DOI: 10.1055/s-0043-1761183
Pictorial Review

Clival and Paraclival Lesions: A Pictorial Review

Delnaz R. Palsetia
1   Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
Antariksh V. Vijan
1   Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
2   Department of Radiodiagnosis and Imaging, Lifescan Imaging Centre & Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
3   Department of Interventional Neuro-Radiology, Wockhardt Hospital, Mumbai, Maharashtra, India
Deepak P. Patkar
4   Department of Imaging, Nanavati Superspecialty Hospital, Mumbai, Maharashtra, India
1   Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
› Author Affiliations


The clivus is a midline anatomical structure in the central skull base. It is affected by a wide range of non-neoplastic, benign and malignant pathologies, some of which typically affect the clivus because of its strategic location and embryological origins. Clival lesions may often be asymptomatic with occasional complaints like headache or cranial neuropathy in few. Cross-sectional imaging techniques, namely, computed tomographic scan and magnetic resonance imaging, thus, play a key role in approximating to the final diagnosis and estimating the disease extent. In this article, we highlight the important imaging features of various clival and paraclival pathologies to facilitate effective diagnosis, therapeutic planning, and management.

Publication History

Article published online:
11 February 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Rai R, Iwanaga J, Shokouhi G. et al. A comprehensive review of the clivus: anatomy, embryology, variants, pathology, and surgical approaches. Childs Nerv Syst 2018; 34 (08) 1451-1458
  • 2 Kunimatsu A, Kunimatsu N. Skull base tumors and tumor-like lesions: a pictorial review. Pol J Radiol 2017; 82: 398-409
  • 3 Chaljub G, Van Fleet R, Guinto Jr FC, Crow WN, Martinez L, Kumar R. MR imaging of clival and paraclival lesions. Am J Roentgenol 1992; 159 (05) 1069-1074
  • 4 Kimura F, Kim KS, Friedman H, Russell EJ, Breit R. MR imaging of the normal and abnormal clivus. Am J Roentgenol 1990; 155 (06) 1285-1291
  • 5 Bahrami S, Yim CM. Quality initiatives: blind spots at brain imaging. Radiographics 2009; 29 (07) 1877-1896
  • 6 Rathore YS, Sinha S, Mahapatra AK. Transsellar transsphenoidal encephalocele: a series of four cases. Neurol India 2011; 59 (02) 289-292
  • 7 Caprioli J, Lesser RL. Basal encephalocele and morning glory syndrome. Br J Ophthalmol 1983; 67 (06) 349-351
  • 8 Chua R, Shapiro S. A mucopyocele of the clivus: case report. Neurosurgery 1996; 39 (03) 589-590 , discussion 590–591
  • 9 Kösling S, Hintner M, Brandt S, Schulz T, Bloching M. Mucoceles of the sphenoid sinus. Eur J Radiol 2004; 51 (01) 1-5
  • 10 Sadashiva N, Nandeesh BN, Shukla D, Bhat D, Somanna S, Devi BI. Isolated sphenoid sinus lesions: experience with a few rare pathologies. J Neurosci Rural Pract 2017; 8 (01) 107-113
  • 11 Fujimoto Y, Harada Y, Toyota S, Wakayama A, So H, Yoshimine T. Primary clival mucocele: case report. Neurol Med Chir (Tokyo) 2011; 51 (03) 250-252
  • 12 Clark MP, Pretorius PM, Byren I, Milford CA. Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base 2009; 19 (04) 247-254
  • 13 Khan MA, Quadri SAQ, Kazmi AS. et al. A comprehensive review of skull base osteomyelitis: diagnostic and therapeutic challenges among various presentations. Asian J Neurosurg 2018; 13 (04) 959-970
  • 14 Bhoi SK, Naik S, Jha M, Pradhan N. Skull base and calvarial tuberculosis presenting as chronic meningitis. Indian J Tuberc 2020; 67 (03) 411-413
  • 15 Indira Devi B, Tyagi AK, Bhat DI, Santosh V. Tuberculous osteitis of clivus. Neurol India 2003; 51 (01) 69-70
  • 16 Razek AA, Huang BY. Lesions of the petrous apex: classification and findings at CT and MR imaging. Radiographics 2012; 32 (01) 151-173
  • 17 Chole RA, Donald PJ. Petrous apicitis. Clinical considerations. Ann Otol Rhinol Laryngol 1983; 92 (6 Pt 1): 544-551
  • 18 Sabeti S, Yousefi F, Pourabdollah Toutkaboni M. Enchondroma of the skull base in a case of Ollier's syndrome. Iran J Pathol 2015; 10 (03) 237-242
  • 19 Agrawal A, Shanthi V, Ramakrishna BA. Giant enchondroma of the clivus. J DattaMeghe Institute Med Sci Uni 2017; 12 (03) 226
  • 20 Gomez CK, Schiffman SR, Bhatt AA. Radiological review of skull lesions. Insights Imaging 2018; 9 (05) 857-882
  • 21 Ustabasioglu FE, Samanci C, Asik M. et al. Aneurysmal bone cyst of sphenoid bone and clivus misdiagnosed as chordoma: a case report. Brain Tumor Res Treat 2015; 3 (02) 115-117
  • 22 Aghaghazvini L, Sedighi N, Karami P, Yeganeh O. Skull base aneurysmal bone cyst presented with foramen jugular syndrome and multi-osseous involvement. Iran J Radiol 2012; 9 (03) 157-160
  • 23 Shibao S, Toda M, Yoshida K. Giant cell tumors of the clivus: case report and literature review. Surg Neurol Int 2015; 6 (Suppl. 25) S623-S627
  • 24 Zhao J, Qian T, Zhi Z. et al. Giant cell tumor of the clivus: a case report and review of the literature. Oncol Lett 2014; 8 (06) 2782-2786
  • 25 Yuh SJ, Woulfe J, Corsten MJ, Carrau RL, Prevedello DM, Kassam AB. Diagnostic imaging dilemma of a clival lesion and its clinical management implications. J Neurol Surg B Skull Base 2014; 75 (03) 177-182
  • 26 Mehnert F, Beschorner R, Küker W, Hahn U, Nägele T. Retroclival ecchordosis physaliphora: MR imaging and review of the literature. Am J Neuroradiol 2004; 25 (10) 1851-1855
  • 27 Theodorou DJ, Theodorou SJ, Kakitsubata Y. Imaging of Paget disease of bone and its musculoskeletal complications: review. AJR Am J Roentgenol 2011; 196 (6, Suppl): S64-S75
  • 28 Baráth K, Huber AM, Stämpfli P, Varga Z, Kollias S. Neuroradiology of cholesteatomas. AJNR Am J Neuroradiol 2011; 32 (02) 221-229
  • 29 Ahmed M, Sureka J, Koshy CG, Chacko BR, Chacko G. Langerhans cell histiocytosis of the clivus: an unusual cause of a destructive central skull base mass in a child. Neurol India 2012; 60 (03) 346-348
  • 30 D'Ambrosio N, Soohoo S, Warshall C, Johnson A, Karimi S. Craniofacial and intracranial manifestations of Langerhans cell histiocytosis: report of findings in 100 patients. Am J Roentgenol 2008; 191 (02) 589-597
  • 31 Erdem E, Angtuaco EC, Van Hemert R, Park JS, Al-Mefty O. Comprehensive review of intracranial chordoma. Radiographics 2003; 23 (04) 995-1009
  • 32 Azzopardi C, Grech R, Mizzi A. Teaching NeuroImages: chordoma. Neurology 2014; 83 (10) e110-e111
  • 33 Raut AA, Naphade PS, Chawla A. Imaging of skull base: pictorial essay. Indian J Radiol Imaging 2012; 22 (04) 305-316
  • 34 Amita R, Sandhyamani S, Nair S, Kapilamoorthy TR. Plasmacytoma of the clivus. Asian J Neurosurg 2017; 12 (03) 573-575
  • 35 Kalwani N, Remenschneider AK, Faquin W, Ferry J, Holbrook EH. Plasmacytoma of the clivus presenting as bilateral sixth nerve palsy. J Neurol Surg Rep 2015; 76 (01) e156-e159
  • 36 Bhartiya M, Pachisia A, Kapoor R, Vardhan V. Clivus and dural involvement in a case of multiple myeloma: a rare complication of multiple myeloma. Indian J Hematol Blood Transfus 2016; 32 (Suppl. 01) 135-137
  • 37 Marinelli JP, Modzeski MC, Lane JI. et al. Primary skull base lymphoma: manifestations and clinical outcomes of a great imitator. Otolaryngol Head Neck Surg 2018; 159 (04) 643-649
  • 38 Deconde AS, Sanaiha Y, Suh JD, Bhuta S, Bergsneider M, Wang MB. Metastatic disease to the clivus mimicking clival chordomas. J Neurol Surg B Skull Base 2013; 74 (05) 292-299
  • 39 Chen X, Dai J, Ai L. et al. Clival invasion on multi-detector CT in 390 pituitary macroadenomas: correlation with sex, subtype and rates of operative complication and recurrence. Am J Neuroradiol 2011; 32 (04) 785-789
  • 40 Rao AB, Koeller KK, Adair CF. Armed Forces Institute of Pathology. From the archives of the AFIP. Paragangliomas of the head and neck: radiologic-pathologic correlation. Radiographics 1999; 19 (06) 1605-1632
  • 41 Debnam JM. Imaging of the head and neck following radiation treatment. Pathol Res Int 2011; 2011: 607820