Treatment of a clivus abscess in a child using image-guidance

(a) Axial and (b) sagittal images of a preoperative computed tomography scan with contrast of the neck demonstrating a 1.7cm×1cm×1.2cm low-attenuating, rim-enhancing mass posterior to the adenoids and extending into the clivus (arrow). Also demonstrated is epidural extension into the spinal canal (block arrow).

An 18 gauge spinal needle attached to a syringe with affixed BrainLAB reference star.

Screen from BrainLAB Vector Vision Compact Unit during localization of the clivus abscess using a reference star attached to syringe with an 18 gauge needle. Note that the end of the needle, as represented by the cross-hairs, is within the abscess cavity.

(a) Axial spoiled gradient with contrast, (b) sagittal T1 fat-suppressed with contrast, and (c) coronal T1 with contrast images of a magnetic resonance image of the brain with gadolinium contrast performed on postoperative day 4 demonstrating continued enhancement of the retropharyngeal soft tissues and clivus (arrow) with resolution of the soft tissue component of the abscess cavity.

(a) Axial spoiled gradient with contrast, (b) sagittal T1 fat-suppressed with contrast, and (c) coronal T1 spin echo with contrast images of a magnetic resonance image of the brain with gadolinium contrast performed on postoperative day 19 demonstrating interval resolution of the rim-enhancing fluid collection (arrow) with persisting nasopharyngeal soft tissue and clivus enhancement. The previously noted dural enhancement and thickening along the clivus is also reduced (block arrow).