A Rare Symptomatic Presentation of Ecchordosis Physaliphora and Unique Endoscope-Assisted Surgical Management

S. T. Cha; R. Jarrahy; W. H. Yong; T. Eby; H. K. Shahinian

doi:10.1055/s-2002-23584

min - Minimally Invasive Neurosurgery, Table of Contents

Minim Invasive Neurosurg 2002; 45(1): 36-40
DOI: 10.1055/s-2002-23584

Original Article

Georg Thieme Verlag Stuttgart · New York

A Rare Symptomatic Presentation of Ecchordosis Physaliphora and Unique Endoscope-Assisted Surgical Management

S. T. Cha¹ , R. Jarrahy¹ , W. H. Yong² , T. Eby¹ , H. K. Shahinian¹

¹Division of Skull Base Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
²Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA

Abstract

We report on the presentation, diagnosis, and surgical management of a rare symptomatic case of ecchordosis physaliphora, including the use of endoscopy as a valuable imaging device in its operative management. A 49-year-old male presented with a intradural extra-axial mass located to the left of the basilar artery in the prepontine space. The tumor was exposed via a transmaxillary transclival approach and resected under binocular microscopic visualization. Prior to and following resection, endoscopes were introduced into the surgical field to conduct anatomic surveys of the region and to assess the completeness of tumor removal. Ecchordosis physaliphora is an uncommon benign lesion originating from embryonic notochordal remnants. It rarely causes clinical symptoms due to its slow growth patterns. Although similarities between EP of the spheno-occiput and chordomas of the clivus make distinction obscure, differentiation is important. Differences in these lesions impact upon patient prognosis as well as therapeutic strategies. The use of endoscopy in the resection of this mass marks an innovative approach to intraoperative imaging of the clival region; improved visualization of the prepontine area allows for more accurate defintion of the surgical anatomy of the tumor and for thorough assessment of the completeness of tumor removal.

Key words

Chordoma - Clival Surgery - Ecchordosis Physaliphora - Endoscopy

Full Text

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Hrayr Shahinian,M. D.

Cedars-Sinai Skull Base Institute

8635 West Third Street

Suite 490W

Los Angeles, CA 90048, USA

Phone: +1-310-423-8091

Fax: +1-310-423-8791

Email: hrayr.shahinian@cshs.org