CSF leak and Ecchordosis Physaliphora: a case series and review of the literature| ACTA Otorhinolaryngologica Italica

Abstract

Background: Ecchordosis physaliphora (EP) is a benign hamartomatous lesion, most commonly found in a restroclival position, as an incidental radiological finding. EP may become symptomatic, by creating a clival defect, leading to CSF leak and meningitis, thus requiring surgical treatment

Methods: Prospective case series.

Results: We present 5 cases of retroclival EP (4 male, 1 female, age range: 34-81) presenting in our department over the last 6 years. Four patients presented with CSF leak – and in two of them this was associated with bacterial meningitis. One patient was and remains asymptomatic with the lesion being an incidental finding. The ecchordosis phylasiphora was treated in all four symptomatic patients with removal of the lesion and reconstruction of the defect with an endoscopic endonasal transclival approach (EETTA). All four patients remain free of symptoms while the lesion has not recurred.

Conclusion: The review of the literature depicts that there is a shift from transcranial approaches to the EETTA for treating retroclival EP. The present case series highlights that EETTA facilitates the complete excision of such lesions, as well the reconstruction of the resulting defects, with minimal morbidity and hospitalization.