Overcoming Challenges: Haemostasis in a Clival Plasmacytoma

Abstract

Solitary plasmacytomas of clivus are a rare entity, having only less than 20 cases reported so far in the literature; its diagnosis and management don't have a gold standard. Although endoscopic skull base surgery (ESBS) is less morbid, it poses a challenge to the surgeon because of the critical location close to vital structures and intraoperative bleeding. Here we present a case report on managing this rare entity and our challenges while dealing with this vascular tumour.

Keywords: Clival lesions; Clival plasmacytoma; Endo-neurosurgery; Endoscopic skull base surgery; Hemostasis in skull base surgery.

Fig. 1

(A) Axial MRI T1 showing low-intermediate intensity mass involving sphenoid with bilateral ICA (*) involvement. (B) Coronal MRI T2 showing intermediate to high signal intensity with bilateral sphenoid and clival involvement. (C) Coronal view CECT Head showing heterogeneously enhancing lesion abutting the basilar artery with atlanto-axial joint (**) involvement. (D) Axial NCCT head showing complete clival destruction with bilateral carotid canal (#) destruction

Fig. 2

(A) Placing Surgicel ® by “four handed technique” over the bleeding areas. (B) Achieving haemostasias with SurgiFlo ®. (C) Hadad-Bassagasteguy flap over the exposed clivus and sella