{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:57:14Z","timestamp":1770116234052,"version":"3.49.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"20","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,5,19]]},"abstract":"\n BACKGROUND<\/jats:title>\n Chordomas and chondrosarcomas are the most common malignant primary clival tumors. Clival metastases are infrequent, and urothelial carcinoma is a rare metastasis source. The case presented shows an isolated clival and bilateral occipital condyle metastasis from urothelial carcinoma without active cancer, initially suspected to be a chordoma.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 68-year-old male with urothelial carcinoma resected 2.3 years prior presented with neck pain and cranial nerve XII palsies. Imaging revealed a clival lesion extending into bilateral occipital condyles, thought to most likely be a chordoma as workup revealed no active systemic cancer. A staged surgical approach was planned beginning with a posterior resection for tissue diagnosis and craniocervical stabilization, to be followed with additional surgical approaches for the remainder of bulk disease. Final pathology revealed metastatic urothelial carcinoma. Accordingly, the patient was treated with radiotherapy and systemic therapy instead of the endonasal transclival and bilateral transcondylar additional staged resections that were planned if the tumor had been a chordoma.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This approach of upfront diagnosis and stabilization allowed identification of a rare and unexpected differential diagnosis prior to coordinating maximal resection across three additional staged surgeries in a patient thought to have a clival chordoma extending to the bilateral occipital condyles.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25139<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25139","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T06:41:55Z","timestamp":1747723315000},"source":"Crossref","is-referenced-by-count":0,"title":["Staged approach to managing aggressive clival lesions extending into occipital condyles illustrated by a rare urothelial carcinoma metastasis: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7271-7022","authenticated-orcid":true,"given":"Kishore","family":"Balasubramanian","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"},{"name":"Texas A&M University College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey A.","family":"Zuccato","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian F.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"J Neurol Surg Rep","first-page":"e156","article-title":"Decision-making in clival mass lesions: risk factors for malignant disease and an illustrative case example","volume":"84","author":"Baier","year":"2023","unstructured":"Baier MPCheong DAShi HHDecision-making in clival mass lesions: risk factors for malignant disease and an illustrative case example. J Neurol Surg Rep. 2023;84(4):e156-e162."},{"issue":"2","key":"bib2","series-title":"Indian J Radiol Imaging","first-page":"201","article-title":"Clival and paraclival lesions: a pictorial review","volume":"33","author":"Palsetia","year":"2023","unstructured":"Palsetia DRVijan AVGala FBSahu ACPatkar DPA AS.Clival and paraclival lesions: a pictorial review. Indian J Radiol Imaging. 2023;33(2):201-217."},{"key":"bib3","series-title":"World Neurosurg","first-page":"190","article-title":"Metastatic lesions of the clivus: a systematic review","volume":"158","author":"Jozsa","year":"2022","unstructured":"Jozsa FDas JM.Metastatic lesions of the clivus: a systematic review. World Neurosurg. 2022;158:190-204."},{"issue":"6","key":"bib4","series-title":"Eur Urol Oncol","first-page":"628","article-title":"Epidemiology, screening, and prevention of bladder cancer","volume":"5","author":"Lobo","year":"2022","unstructured":"Lobo NAfferi LMoschini MEpidemiology, screening, and prevention of bladder cancer. Eur Urol Oncol. 2022;5(6):628-639."},{"issue":"2","key":"bib5","series-title":"Urology","first-page":"142","article-title":"Metastases from transitional cell carcinoma of urinary bladder","volume":"16","author":"Babaian","year":"1980","unstructured":"Babaian RJJohnson DELlamas LAyala AG.Metastases from transitional cell carcinoma of urinary bladder. Urology. 1980;16(2):142-144."},{"issue":"8","key":"bib6","series-title":"Cureus","first-page":"e17257","article-title":"Solitary calvarial metastasis as the first presentation of urothelial bladder cancer","volume":"13","author":"Bistazzoni","year":"2021","unstructured":"Bistazzoni SBonetto SDomenico Bellocchi S.Solitary calvarial metastasis as the first presentation of urothelial bladder cancer. Cureus. 2021;13(8):e17257."},{"issue":"1","key":"bib7","series-title":"Case Rep Neurol","first-page":"24","article-title":"Sixth cranial nerve palsy and craniocervical junction instability due to metastatic urothelial bladder carcinoma","volume":"11","author":"Nasi","year":"2019","unstructured":"Nasi DDobran Mdi Somma LSantinelli AIacoangeli M.Sixth cranial nerve palsy and craniocervical junction instability due to metastatic urothelial bladder carcinoma. Case Rep Neurol. 2019;11(1):24-31."},{"issue":"9","key":"bib8","series-title":"Medicina (Kaunas)","first-page":"987","article-title":"A rare case report of metastatic urothelial carcinoma to skull with significant reossification after pembrolizumab","volume":"57","author":"Liu","year":"2021","unstructured":"Liu YHChou MHMeng EKao CC.A rare case report of metastatic urothelial carcinoma to skull with significant reossification after pembrolizumab. Medicina (Kaunas). 2021;57(9):987."},{"issue":"6","key":"bib9","series-title":"Cureus","first-page":"e63171","article-title":"Bladder carcinoma with solitary skull metastasis: a rare presentation in a middle-aged female","volume":"16","author":"Suryadevara","year":"2024","unstructured":"Suryadevara MMishra GVParihar PBladder carcinoma with solitary skull metastasis: a rare presentation in a middle-aged female. Cureus. 2024;16(6):e63171."},{"key":"bib10","series-title":"BMC Urol","first-page":"5","article-title":"Long term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors: tumor recurrence and worsening progression","volume":"14","author":"Kobayashi","year":"2014","unstructured":"Kobayashi HKikuchi EMikami SLong term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors: tumor recurrence and worsening progression. BMC Urol. 2014;14:5."},{"issue":"1","key":"bib11","series-title":"Eur Urol Focus","first-page":"189","article-title":"Long-term recurrence rates of low-risk non-muscle-invasive bladder cancer-how long is cystoscopic surveillance necessary?","volume":"10","author":"Ma","year":"2024","unstructured":"Ma JRoumiguie MHayashi TLong-term recurrence rates of low-risk non-muscle-invasive bladder cancer-how long is cystoscopic surveillance necessary? Eur Urol Focus. 2024;10(1):189-196."},{"issue":"1","key":"bib12","series-title":"World J Surg Oncol","first-page":"402","article-title":"A rare case of bladder cancer that metastasized to brain, heart, and lung lymph nodes benefited from immunotherapy","volume":"20","author":"Zhu","year":"2022","unstructured":"Zhu LKLi ZJWang ZBA rare case of bladder cancer that metastasized to brain, heart, and lung lymph nodes benefited from immunotherapy. World J Surg Oncol. 2022;20(1):402."},{"issue":"2","key":"bib13","series-title":"AJNR Am J Neuroradiol","first-page":"309","article-title":"Percutaneous CT-guided skull biopsy: feasibility, safety, and diagnostic yield","volume":"40","author":"Tomasian","year":"2019","unstructured":"Tomasian AHillen TJJennings JW.Percutaneous CT-guided skull biopsy: feasibility, safety, and diagnostic yield. AJNR Am J Neuroradiol. 2019;40(2):309-312."},{"issue":"4","key":"bib1","series-title":"J Neurol Surg Rep","first-page":"e156","article-title":"Decision-making in clival mass lesions: risk factors for malignant disease and an illustrative case example","volume":"84","author":"Baier","year":"2023","unstructured":"Baier MPCheong DAShi HHDecision-making in clival mass lesions: risk factors for malignant disease and an illustrative case example. J Neurol Surg Rep. 2023;84(4):e156-e162."},{"issue":"2","key":"bib2","series-title":"Indian J Radiol Imaging","first-page":"201","article-title":"Clival and paraclival lesions: a pictorial review","volume":"33","author":"Palsetia","year":"2023","unstructured":"Palsetia DRVijan AVGala FBSahu ACPatkar DPA AS.Clival and paraclival lesions: a pictorial review. 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Case Rep Neurol. 2019;11(1):24-31."},{"issue":"9","key":"bib8","series-title":"Medicina (Kaunas)","first-page":"987","article-title":"A rare case report of metastatic urothelial carcinoma to skull with significant reossification after pembrolizumab","volume":"57","author":"Liu","year":"2021","unstructured":"Liu YHChou MHMeng EKao CC.A rare case report of metastatic urothelial carcinoma to skull with significant reossification after pembrolizumab. Medicina (Kaunas). 2021;57(9):987."},{"issue":"6","key":"bib9","series-title":"Cureus","first-page":"e63171","article-title":"Bladder carcinoma with solitary skull metastasis: a rare presentation in a middle-aged female","volume":"16","author":"Suryadevara","year":"2024","unstructured":"Suryadevara MMishra GVParihar PBladder carcinoma with solitary skull metastasis: a rare presentation in a middle-aged female. Cureus. 2024;16(6):e63171."},{"key":"bib10","series-title":"BMC Urol","first-page":"5","article-title":"Long term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors: tumor recurrence and worsening progression","volume":"14","author":"Kobayashi","year":"2014","unstructured":"Kobayashi HKikuchi EMikami SLong term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors: tumor recurrence and worsening progression. BMC Urol. 2014;14:5."},{"issue":"1","key":"bib11","series-title":"Eur Urol Focus","first-page":"189","article-title":"Long-term recurrence rates of low-risk non-muscle-invasive bladder cancer-how long is cystoscopic surveillance necessary?","volume":"10","author":"Ma","year":"2024","unstructured":"Ma JRoumiguie MHayashi TLong-term recurrence rates of low-risk non-muscle-invasive bladder cancer-how long is cystoscopic surveillance necessary? Eur Urol Focus. 2024;10(1):189-196."},{"issue":"1","key":"bib12","series-title":"World J Surg Oncol","first-page":"402","article-title":"A rare case of bladder cancer that metastasized to brain, heart, and lung lymph nodes benefited from immunotherapy","volume":"20","author":"Zhu","year":"2022","unstructured":"Zhu LKLi ZJWang ZBA rare case of bladder cancer that metastasized to brain, heart, and lung lymph nodes benefited from immunotherapy. World J Surg Oncol. 2022;20(1):402."},{"issue":"2","key":"bib13","series-title":"AJNR Am J Neuroradiol","first-page":"309","article-title":"Percutaneous CT-guided skull biopsy: feasibility, safety, and diagnostic yield","volume":"40","author":"Tomasian","year":"2019","unstructured":"Tomasian AHillen TJJennings JW.Percutaneous CT-guided skull biopsy: feasibility, safety, and diagnostic yield. 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