Endoscopic Resection of a Giant Intradural Retroclival Ecchordosis Physaliphora

Objective: We report the first complete resection of a giant ecchordosis physaliphora (EP) using an endoscopic transclival approach. We describe the surgical technique employed and provide a current review of the literature.

Case Description: This rare benign lesion, originating from embryonic notochordal remnants, was located in the prepontine cistern of a 63-year-old male presenting with progressive tremor and imbalance. Preoperative imaging demonstrated a 2.1 cm intradural lesion abutting the pons and basilar artery and extending through the dura. A gross-total resection was successfully achieved endoscopically without neurovascular compromise or additional complications. Postoperative histopathologic examination was consistent with a diagnosis of giant EP.

Conclusions: Our result is consistent with similar less invasive and more direct approaches in the treatment of skull-base chordomas. Longer follow-up and larger cohort studies will determine the extent of benefit over traditional approaches for long-term control. Our experience, however, highlights the potential of endoscopy, including enhanced tumor resection and improved visualization of critical neighboring neurovascular structures, in the management of EP and other cranial base neoplasms.