A case of ecchordosis physaliphora presenting with an abducens nerve palsy: A rare symptomatic case managed with endoscopic endonasal transsphenoidal surgery

Background: Ecchordosis physaliphora (EP) is a benign notochordal remnant that is usually asymptomatic; symptomatic cases are extremely rare. Most of the reported symptomatic cases were managed by resection via craniotomy. Case Description: We report a case of a 20-year-old male presenting with abducens nerve palsy. Magnetic resonance imaging performed on admission demonstrated a mass in the retroclival prepontine location. The patient was treated successfully by endoscopic endonasal trans-sphenoidal surgery (ETSS), his postoperative course was uneventful, and the abducens nerve palsy disappeared. Conclusion: ETSS has advantages not only for treatment but also for differentiation between EP and intradural chordoma. This is the first case of symptomatic EP successfully treated solely by ETSS.

[1]  M. Hameed,et al.  Intraosseous benign notochordal cell tumor. , 2010, Archives of pathology & laboratory medicine.

[2]  T. Yildirim,et al.  A case of ecchordosis physaliphora presenting with an intratumoral hemorrhage. , 2009, Turkish neurosurgery.

[3]  D. Mazzatenta,et al.  INTRADURAL CLIVAL CHORDOMA AND ECCHORDOSIS PHYSALIPHORA: A CHALLENGING DIFFERENTIAL DIAGNOSIS CASE REPORT , 2009, Neurosurgery.

[4]  T. Miki,et al.  Neuroendoscopic Trans-third Ventricle Approach for Lesions of the Ventral Brainstem Surface , 2008, Minimally invasive neurosurgery : MIN.

[5]  W. Paulus,et al.  Sudden death due to subarachnoid bleeding from ecchordosis physaliphora , 2008, International Journal of Legal Medicine.

[6]  P. Robbins,et al.  A Case of Giant Ecchordosis Physaliphora: A Case Report and Literature Review , 2007, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[7]  G. Mirone,et al.  A rare symptomatic presentation of ecchordosis physaliphora: neuroradiological and surgical management , 2007, Journal of Neurology, Neurosurgery & Psychiatry.

[8]  R. Shirane,et al.  Notochordal remnant-derived mass: ecchordosis physaliphora or chordoma? , 2006, Pathology.

[9]  T. Nägele,et al.  Retroclival ecchordosis physaliphora: MR imaging and review of the literature. , 2004, AJNR. American journal of neuroradiology.

[10]  H. Shahinian,et al.  A rare symptomatic presentation of ecchordosis physaliphora and unique endoscope-assisted surgical management. , 2002, Minimally invasive neurosurgery : MIN.

[11]  A. Kondo,et al.  Neuroradiological characteristics of ecchordosis physaliphora. Case report and review of the literature. , 1998, Journal of neurosurgery.

[12]  T. Hashimoto,et al.  [A surgical case of ecchordosis physaliphora]. , 1996, No shinkei geka. Neurological surgery.

[13]  P. Gullane,et al.  Cerebrospinal fluid fistula secondary to ecchordosis physaliphora. , 1990, Neurosurgery.

[14]  W. Kamphorst,et al.  Ecchordosis physaliphora as a cause of fatal pontine hemorrhage. , 1982, European neurology.

[15]  W. Mccormick,et al.  Ecchordosis physaliphora. An electron microscopic study. , 1971, Journal of neurosurgery.

[16]  M. Stewart,et al.  ECCHORDOSIS PHYSALIPHORA SPHENO-OCCIPITALIS , 1923, The Journal of neurology and psychopathology.