Successful endoscopic endonasal management of a transclival cerebrospinal fluid fistula secondary to ecchordosis physaliphora – An ectopic remnant of primitive notochord tissue in the clivus

MR scans often evidence homogeneous masses that present hypointense and hyperintense signals on T1 and T2-weighted images, respectively [1]. Because EP is a scarcely vascularized lesion, enhancement after contrast administration is usually absent [1,4]. [...]it was opted to perform an endoscopic endonasal approach to treat the patient in the case reported. 2 transferrin levels Clinically suspected Infectious complication (bacterial meningitis) NO YES (after radiological confirmation of CSF fistula) YES (at presentation) CT findings Mass spanning a clival defect, air-fluid level within the sphenoid sinus Mass spanning a clival defect, air-fluid level within the sphenoid sinus Mass spanning a clival defect, air-fluid level within the sphenoid sinus MRI characteristics T1 ? ? ? T2 ? ? ? Contrast enhancement -a No No Histopathology Confirmed -a Confirmed Immunohistochemistry -a -a Confirmed Surgical approach Sublabial midline rhinoseptal transsphenoidal Endoscopic endonasal (unsuccessful) -Microscopic transsphenoidal Endoscopic endonasal Table 1 Comparison between the case reports of CSF fistula secondary to EP registered in the literature and the case presented.