title: Clival Metastasis of a Duodenal Adenocarcinoma: A Case Report and Literature Review.
abstract: BACKGROUND
  Clival metastases of adenocarcinomas are exceptionally rare tumors, especially when they arise from the small intestine. We present the first, to our knowledge, report of a metastasis of a duodenal adenocarcinoma to the clivus. We also present a systematic review detailing metastasis to the clivus.
  
  
  METHODS
  Studies were identified using the search terms "clival metastasis," "skull base metastasis," and "clivus" in PubMed. We collected the following information: histopathology of the primary tumor, symptoms, history, treatment, and follow-up.
  
  
  RESULTS
  A comprehensive review of the literature yielded 56 cases. Patients developed the first symptoms of clival metastasis at a mean age of 58 years. The most common primary neoplasms originated from the prostate, kidney, or liver. Most patients presented with an isolated sixth nerve palsy or diplopia. The time interval from diagnosis of the primary tumor to symptomatic presentation of clival metastasis ranged from 2 months to 33 years. Sixteen patients initially presented with symptoms of clival metastasis without a previously diagnosed primary tumor. Survival data were available for 35 patients, of which 63% died within a range of 2 days to 31 months after initial presentation.
  
  
  CONCLUSIONS
  Most primary neoplasms originated from the prostate, kidney, and liver, which differ from previous reports on skull base metastases. Abducens nerve palsy is often the first presentation of clival metastasis. Clival metastasis from duodenal carcinoma, although very rare, should be considered in the differential diagnosis of bony lesions of the clivus in a patient with a history of duodenal adenocarcinoma.
authors.affiliation: Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. Electronic address: simone.dekker@UHhospitals.org.
authors.forename: Simone E
authors.initials: SE
authors.lastname: Dekker
authors.affiliation: Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Wasman
authors.affiliation: Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Yoo
authors.affiliation: Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alonso
authors.affiliation: Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Tarr
authors.affiliation: Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Bambakidis
authors.affiliation: Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rodriguez
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000368:Aged; D003388:Cranial Fossa, Posterior; D004379:Duodenal Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery
keywords: Abducens nerve palsy; Clival metastasis; Duodenal adenocarcinoma