Sphenoclival intraosseus lipoma: case report and literature review.

Objective: To present the case of a rare tumor in the sphenoidoclival area and discuss potential pitfalls in diagnosis and management.

Design: Case report with literature review.

Setting: Tertiary referral center.

Case Summary: Our patient presented with headache, vertigo, vision problems, and feeling of pressure in the central segment of the face. MR and CT showed a lesion in the body of the sphenoid, with signs of bone destruction and irregular borders. Differential diagnosis included intraosseous meningioma, chordoma, and inflammatory process.

Results: Endoscopic/microscopic transnasal approach was performed to reach clival bone and to biopsy the tumor. Histopathological examination showed intraosseous lipoma.

Conclusion: Intraosseous lipoma is a rare tumor, or more accurately a hamartoma, and is usually found in the calcaneus or in the proximal femur. It is even rarer in the skull base. Usually it does not present any symptoms and is an incidental finding during imaging for other symptoms. As a rule it runs an indolent course and does not require any treatment. Since no definitive diagnosis can be made only on the basis of imaging (CT and MRI), it requires an open biopsy that if possible should be made in accordance with the principles of minimally invasive surgery.