Neuroendoscopic Trans-Third Ventricular Approach for Surgical Management of Ecchordosis Physaliphora

Adib, Sasan Darius; Bisdas, Sotirios; Bornemann, Antje; Schuhmann, Martin U.

doi:10.1016/j.wneu.2016.02.041

Cited by 11 publications

(4 citation statements)

References 34 publications

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“…However, the approach is limited to single-instrument manipulation and is more applicable to lesions extending into the posterior clivus. Via third-ventricle approaches lesions adherent to neurovascular structures may be difficult to totally resect [23]. In our case, an endoscopic endonasal transsphenoidal approach to the clivus was used given the extension of the lesion into the sphenoid sinus.…”

Section: Discussionmentioning

confidence: 96%

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

Lindemann¹,

Kamrava²,

Chakraborty³

et al. 2019

J Head Neck Surg

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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.

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Section: Discussionmentioning

confidence: 96%

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

Lindemann¹,

Kamrava²,

Chakraborty³

et al. 2019

J Head Neck Surg

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“…A literature review in 2013 identified 23 case reports of symptomatic EP 29 and our literature search revealed an additional 8 cases. 24 30 31 32 33 34 35 Symptoms included diplopia, cranial nerve VI palsy, facial dysesthesia, headache, confusion, dizziness, hearing loss, tinnitus, facial pain, hemiparesis, and sudden death due to intratumoral bleed. 25 36 The reported cases also include six cases of rhinorrhea secondary to spontaneous CSF fistula.…”

Section: Discussionmentioning

confidence: 99%

Do All Notochordal Lesions Require Proton Beam Radiotherapy? A Proposed Reclassification of Ecchordosis Physaliphora as Benign Notochord Cell Tumor

Sooltangos

Bódi

Ghimire

et al. 2021

J Neurol Surg B Skull Base

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Objectives Ecchordosis physaliphora (EP) is a benign notochord lesion of the clivus arising from the same cell line as chordoma, its malignant counterpart. Although usually asymptomatic, it can cause spontaneous cerebrospinal fluid (CSF) rhinorrhea. Benign notochordal cell tumor (BNCT) is considered another indolent, benign variant of chordoma. Although aggressive forms of chordoma require maximal safe resection followed by proton beam radiotherapy, BNCT and EP can be managed with close imaging surveillance without resection or radiotherapy. However, while BNCT and EP can be distinguished from more aggressive forms of chordoma, differentiating the two is challenging as they are radiologically and histopathologically identical. This case series aims to characterize the clinicopathological features of EP and to propose classifying EP and BNCT together for the purposes of clinical management. Design Case series. Setting Tertiary referral center, United Kingdom. Participants Patients with suspected EP from 2015 to 2019. Main Outcome Measures Diagnosis of EP. Results Seven patients with radiological suspicion of EP were identified. Five presented with CSF rhinorrhea and two were asymptomatic. Magnetic resonance imaging features consistently showed T1-hypointense, T2-hyperintense nonenhancing lesions. Diagnosis was made on biopsy for patients requiring repair and radiologically where no surgery was indicated. The histological features of EP included physaliphorous cells of notochordal origin (positive epithelial membrane antigen, S100, CD10, and/or MNF116) without mitotic activity. Conclusion EP is indistinguishable from BNCT. Both demonstrate markers of notochord cell lines without malignant features. Their management is also identical. We therefore propose grouping EP with BNCT. Close imaging surveillance is required for both as progression to chordoma remains an unquantified risk.

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“…7 The different surgical approaches for symptomatic EP depend on tumour size and location, and the aim of the operation is total resection. 2 The annual incidence of abducens paralysis is 11.3/.100,000. 8 The most common causes are microvascular infarction (28%), trauma (5%), neoplasm (5%), aneurysm (4%), and others (20%), but in many instances, they are idiopathic (24%).…”

Section: Discussionmentioning

confidence: 99%

An Incidental Finding of Ecchordosis Physaliphora in a Case of Abducens Nerve Palsy: Case Report

Ilorah

Bond

Kattah

et al. 2017

Neuro-Ophthalmology

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Ecchordosis physaliphora (EP) is a rare non-malignant mass that originates from remains of the notochord and is typically asymptomatic. A 42-year-old man presented with sudden onset of painless horizontal diplopia and his neurological exam showed sixth cranial nerve palsy. Magnetic resonance imaging (MRI) identified a non-enhanced retroclival mass (EP) with increased signal intensity on T2 and decreased signal intensity on T1-weighted sequences. He was treated with methylprednisolone, completely recovered in four weeks and has remained symptom free. Conservative management should be attempted before surgery in all cases since symptoms can resolve spontaneously and EP could be an incidental finding.

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Neuroendoscopic Trans-Third Ventricular Approach for Surgical Management of Ecchordosis Physaliphora

Cited by 11 publications

References 34 publications

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

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

Do All Notochordal Lesions Require Proton Beam Radiotherapy? A Proposed Reclassification of Ecchordosis Physaliphora as Benign Notochord Cell Tumor

An Incidental Finding of Ecchordosis Physaliphora in a Case of Abducens Nerve Palsy: Case Report

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