Endoscopic Transsphenoidal Management of Ecchordosis Physaliphora in the Sphenoid Sinus: A Case Report and Review of Approaches to Resection

Abstract

Background: Ecchordosis Physaliphora (EP) is a benign lesion originating from the developing notochord, similar to chordoma. We report complete resection of an asymptomatic, extradural EP in the sphenoid sinus using an endoscopic transsphenoidal approach and review surgical approaches to resection. Case description:A 35-year-old woman presented with headache and a family history of multiple sclerosis. Radiologic imaging revealed a 2.6 cm T1 hypointense, T2 hyperintense lesion extending from the dorsal clivus into the posterior aspect of the sphenoid sinus. An endoscopic endonasal transsphenoidal approach facilitated inspection and complete resection of the extradural lesion. Combined clinical, radiographic, surgical, and histopathologic findings confirmed the diagnosis of EP.Conclusions: Endoscopic approaches to resection allow for excellent visualization and resection of clival EPs. Endoscopic endonasal transsphenoidal approaches are minimally invasive options for resection of EP of the anterior clivus, particularly for lesions extending into the sphenoid sinus. While total resection is desirable, there are currently no reported EP recurrences after resection.