Association of meningitis and clival canal defect: case illustration, management, and systematic review of the literature

Author:

Singh Rohin1,Thorwarth Ryan M.2,Bendok Bernard R.34,Rath Tanya J.5,Bhuskute Aditi A.6,Gnagi Sharon H.6,Lal Devyani3

Affiliation:

1. Mayo Clinic Alix School of Medicine, Scottsdale;

2. Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Phoenix;

3. Department of Otolaryngology, Mayo Clinic Hospital, Phoenix;

4. Department of Neurologic Surgery, Mayo Clinic Hospital, Phoenix; and

5. Department of Radiology, Mayo Clinic Hospital, Phoenix;

6. Department of Otolaryngology, Phoenix Children’s Hospital, Phoenix, Arizona

Abstract

OBJECTIVE Improper embryological development of the clivus, a bony structure that comprises part of the skull base, can lead to a clival canal defect. Previously thought to be a benign condition, clival canals have been reported to be associated with meningitis and meningoceles. In this review, the authors sought to present an unpublished case of a patient with a clival canal defect associated with meningitis and to evaluate all other reported cases. METHODS In October 2020, a search of PubMed, Web of Science, and Scopus was conducted to identify all cases of clival canals reported from January 1, 1980, through October 31, 2020. RESULTS Including the case presented herein, 13 cases of clival canals, 11 in children (84.6%) and 2 in adults (15.4%), have been identified. Of the pediatric patients, 5 (45.5%) had an associated meningocele, and 8 (72.7%) had meningitis. Nine of the 13 patients (69.2%) had defects that were treated surgically, 5 (38.5%) by a transnasal approach and 4 (30.8%) by a transoral approach. Two patients (15.4%) were treated with drainage and antibiotics, 1 patient (7.7%) was treated solely with antibiotics, and 1 patient (7.7%) was not treated. In the literature review, 8 reports of clival canals were found to be associated with meningitis, further contributing to the notion that the clival canal may be an overlooked source of recurrent infection. In several of these cases, surgical repair of the lesion was curative, thus preventing continued episodes of meningitis. CONCLUSIONS When a patient has recurrent meningitis with no clear cause, taking a closer look at clival anatomy is recommended. In addition, if a clival canal defect has been identified, surgical repair should be considered a safe and effective primary treatment option.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

Reference28 articles.

1. Endoscopic endonasal transclival approach to tumors of the clivus and anterior region of the posterior cranial fossa: an anatomic study;Shkarubo AN,2018

2. Developmental considerations in pediatric skull base surgery;LoPresti MA,2018

3. A comprehensive review of the clivus: anatomy, embryology, variants, pathology, and surgical approaches;Rai R,2018

4. Clival canal and clival foramen development in the fetal and infant basioccipital;Zdilla MJ,2017

5. The clivus: anatomy, normal variants and imaging pathology;Hofmann E,2012

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