CSF Leak—First Symptom of a Chordoma of the Clivus

Background: Introduction of a 37-year-old male patient who was admitted in our hospital with a chordoma of the clivus. Some months earlier he had tried to blow up a balloon and remarked some fluid running through his nose. By admission he presented with headache. The CT and MRI of the brain showed a CSF leak in the region of the clivus. He had been under treatment with antibiotics for a sinusitis. Methods: The patient was operated. We took a biopsy and closed the fistula. After surgery CSF was running through the nose. We repeated four times a lumbar puncture. After that there was no rhinoliquorrhea anymore. The patient could leave the hospital at first. Some weeks later he had to be admitted again with CSF running through the nose. Another surgery was performed and afterward the leakage was closed. The histological result of the biopsy revealed a chordoma of the clivus. Further therapy was performed in another hospital. Results: Chordoma affect mostly the skull base and the coccygeal bone. Men seem to be more often affected than women. They occur mostly after the age of 30. A spontaneous CSF leak might be the first symptom of a chordoma of the clivus.