case_images: PMC9280865_01
case_images: T1 postcontrast MRI demonstrating an avidly enhancing extra-axial clival tumor with brainstem compression. A, Sagittal. B, Coronal. C, Axial.
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case_images: F1
case_images: MRI brain demonstrated an avidly enhancing and T2 hyperintense retroclival mass with significant mass effect on the adjacent brainstem, cranial nerves, and vascular structures (Figure 1).
case_images: PMC9280865_02
case_images: Multiple views of angiogram demonstrating brisk filling of the tumor via anterior and posterior circulation. A, Left vertebral artery run, AP view. B, Right internal carotid artery run, lateral view.
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case_images: F2
case_images: Preoperatively, the patient underwent preoperative angiography to better delineate the tumors relationship to the posterior circulation (Figure 2).
case_images: A-C, Intraoperative findings of clival paraganglioma, including cranial nerve V, the cranial nerve VII/VIII complex, and the basilar artery with adherent tumor.
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case_images: F3
case_images: The following day, she underwent a combined left extended retrosigmoid craniotomy, temporal craniotomy, and posterior petrosectomy with neurosurgery and neuro-otology with stereotaxy, SSEP, MEP, and monitoring of cranial nerves V, VII, VIII, IX and X This approach was chosen to minimize retraction of normal cerebellum in this young patient, as well as to provide access to both the supratentorial and infratentorial compartments (Figure 3).
case_images: PMC9280865_03
case_images: Pathology demonstrating fibrous tissue consisting of nests and clusters of cells that display hyperchromatic nuclei, coarsely granular chromatin and moderate to abundant eosinophilic cytoplasm. A, H&E (40x). B, Synaptophysin stain. C, Chromogranin stain.
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case_images: F4
case_images: This pathologic profile was consistent with a paraganglioma (Figure 4).
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case_images: PMC9280865_05
case_images: A-C, Fractionated radiation treatment planning.
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case_images: F5
case_images: A discussion regarding management of residual was held with the patient and a multi-disciplinary tumor board, and the decision was made to refer to radiation oncology for fractionated conformal radiotherapy of small residual disease (Figure 5).