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Neurosurgery. 2009 Feb;64(2):E387-8; discussion E388. doi: 10.1227/01.NEU.0000337064.57270.F0.

Intradural clival chordoma and ecchordosis physaliphora: a challenging differential diagnosis: case report.

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Center of Surgery for Pituitary Tumours and Endoscopic Skull Base Surgery, Neurosurgical Department, Bellaria Hospital, Bologna, Italy.



Purely intradural clival chordomas are rare neoplasms, and only a few cases have been reported. The reported cases present features similar to ecchordosis physaliphora, which is a notochordal remnant. We describe these 2 entities and their differential diagnoses, clinical courses, and management. This is the first reported case to be treated using a neuroendoscopic technique.


A 60-year-old man presenting with memory loss underwent magnetic resonance imaging, which revealed an intradural retroclival mass without bone involvement.


The patient underwent an endoscopic transsphenoidal-transclival procedure with subtotal removal of the tumor. Histological findings confirmed the diagnosis of a chordoma.


Even if some parameters exist for a differential diagnosis, ecchordosis physaliphora and intradural chordoma may represent different aspects of the spectrum of the same pathology. Intradural clival chordomas have a better prognosis with respect to classic chordomas. Therefore, in subtotal removal such as that performed in our case, postoperative radiation therapy should be performed only if a regrowth of the remnant is seen during neuroradiological follow-up.

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