Ecchordosis physaliphora of the clivus: a case series and narrative review of the literature.

Background: Ecchordosis physaliphora (EP) is a benign hamartomatous lesion, most commonly found in a retroclival 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: Retrospective case series. Results: We present 5 cases of retroclival EP (4 males, 1 female; age range, 34-81 years) presenting in our department over the last 6 years. Four patients presented with CSF leak; 3 also had a history of bacterial meningitis, while one was diagnosed with meningitis on presentation. One patient was and remains asymptomatic 28 months later with the lesion being an incidental finding. The EP was treated in all 4 symptomatic patients with removal of the lesion and reconstruction of the defect with an endoscopic endonasal transclival approach (EETTA). All 4 patients remain free of symptoms while the lesion has not recurred for 81, 72, 52, and 22 months, respectively. Conclusions: A 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 EP lesions, as well the reconstruction of the resulting defects, with minimal morbidity and hospitalisation.