DOI: https://doi.org/10.36347/sjmcr.2026.v14i09.018

Pages: 2033-2035

Giant cell tumor of bone (GCTB) is a locally aggressive neoplasm that rarely involves the skull base. We report the case of a 15-year-old girl with a primary sphenoid GCTB presenting with progressive visual impairment, diplopia, and strabismus. Imaging revealed an extensive locally aggressive sphenoid lesion involving critical skull base structures. After initially non-contributory biopsies, a repeat sphenoid biopsy established the diagnosis of GCTB based on morphological and immunohistochemical findings. Given the challenging location and the high morbidity associated with surgical resection, treatment with denosumab was initiated. The patient experienced rapid improvement in visual function after the first injection, followed by sustained clinical improvement and a favorable radiological response with tumor regression and calcification. Multidisciplinary reassessment ultimately supported continuation of medical therapy without surgery. This case highlights the potential of denosumab as an effective, function-preserving therapeutic strategy for selected patients with locally advanced sphenoid GCTB, allowing sustained disease control while avoiding high-risk surgery.