{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:48:22Z","timestamp":1770115702169,"version":"3.49.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,6,2]]},"abstract":"\n BACKGROUND<\/jats:title>\n Chordomas are rare neoplasms derived from the notochord, primarily affecting the skull base and sacral regions. While cranial nerve deficits are common, CSF rhinorrhea as an initial symptom is rare. Ecchordosis physaliphora (EP), another notochord-derived lesion, is typically asymptomatic but may also be present with CSF leakage. Differentiating between these entities remains challenging due to overlapping histopathological and imaging features.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors report the case of a woman in her 50s with persistent CSF rhinorrhea for 4 months. Imaging revealed a central clival defect with mucosal protrusion, and endoscopic endonasal repair identified a fragile, whitish lesion. Histopathological examination confirmed a chordoma with features suggestive of EP, including low Ki-67 labeling. Given the lack of contrast enhancement on MRI and the benign clinical course, EP was suspected rather than an aggressive chordoma.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case highlights the need to consider notochordal lesions in patients with idiopathic CSF rhinorrhea, particularly with clival defects. When CSF leakage with a suspected fistula at the central clivus is encountered, a notochord-derived lesion should be considered, and skull base reconstruction should be performed accordingly.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25157<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25157","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T19:46:03Z","timestamp":1749498363000},"source":"Crossref","is-referenced-by-count":0,"title":["Notochord-derived lesion presenting with cerebrospinal fluid rhinorrhea: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Takayuki","family":"Ishikawa","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya City, Aichi Prefecture, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuyasu","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya City, Aichi Prefecture, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7705-5438","authenticated-orcid":true,"given":"Tetsuya","family":"Nagatani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya City, Aichi Prefecture, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Arch Pathol Lab Med","first-page":"386","article-title":"Chordoma","volume":"146","author":"Ulici","year":"2022","unstructured":"Ulici VHart J.Chordoma. Arch Pathol Lab Med. 2022;146(3):386-395."},{"issue":"9","key":"bib2","series-title":"J Neurosurg Case Lessons","first-page":"CASE23177","article-title":"A rare case of multifocal chordoma involving the lower clivus and multiple spine levels: illustrative case","volume":"6","author":"Alsavaf","year":"2023","unstructured":"Alsavaf MBSalem EHJawad BAMongkolkul KCarrau RLPrevedello DM.A rare case of multifocal chordoma involving the lower clivus and multiple spine levels: illustrative case. J Neurosurg Case Lessons. 2023;6(9):CASE23177."},{"issue":"8","key":"bib3","series-title":"J Clin Neurosci","first-page":"1083","article-title":"Transclival cerebrospinal fluid rhinorrhea as the initial presenting symptom of a tiny intradural chordoma","volume":"17","author":"Feng","year":"2010","unstructured":"Feng KQiuhang ZQiuyi Q.Transclival cerebrospinal fluid rhinorrhea as the initial presenting symptom of a tiny intradural chordoma. J Clin Neurosci. 2010;17(8):1083-1085."},{"issue":"7","key":"bib4","series-title":"No Shinkei Geka","first-page":"601","article-title":"A case report of clivus chordoma presenting with cerebrospinal fluid rhinorrhea","volume":"48","author":"Ujikawa","year":"2020","unstructured":"Ujikawa TTanaka YOnaka KA case report of clivus chordoma presenting with cerebrospinal fluid rhinorrhea. No Shinkei Geka. 2020;48(7):601-606."},{"issue":"4","key":"bib5","series-title":"Surg Neurol","first-page":"331","article-title":"Endonasal microscopic removal of clival chordomas","volume":"69","author":"Fatemi","year":"2008","unstructured":"Fatemi NDusick JRGorgulho AAEndonasal microscopic removal of clival chordomas. Surg Neurol. 2008;69(4):331-338."},{"issue":"14","key":"bib6","series-title":"J Neurosurg Case Lessons","first-page":"CASE2347","article-title":"Chronic cerebrospinal fluid rhinorrhea as an initial presentation of chordoma: illustrative case","volume":"5","author":"Prather","year":"2023","unstructured":"Prather KYShi HHMcKinney KADunn IF.Chronic cerebrospinal fluid rhinorrhea as an initial presentation of chordoma: illustrative case. J Neurosurg Case Lessons. 2023;5(14):CASE2347."},{"issue":"5","key":"bib7","series-title":"Rinsho Shinkeigaku","first-page":"264","article-title":"A case of chordoma presenting as recurrent bacterial meningitis with cerebrospinal fluid leakage","volume":"59","author":"Ando","year":"2019","unstructured":"Ando SUsuda HUmeda YUmeda MOyake MFujita N.A case of chordoma presenting as recurrent bacterial meningitis with cerebrospinal fluid leakage. Rinsho Shinkeigaku. 2019;59(5):264-267."},{"issue":"4","key":"bib8","series-title":"Neurol India","first-page":"513","article-title":"Spontaneous cerebrospinal fluid rhinorrhea: a rare initial presentation of clival chordoma","volume":"57","author":"Hsieh","year":"2009","unstructured":"Hsieh CTLiu MYSu WFJu DT.Spontaneous cerebrospinal fluid rhinorrhea: a rare initial presentation of clival chordoma. Neurol India. 2009;57(4):513-514."},{"key":"bib9","series-title":"J Med Case Rep","first-page":"410.","article-title":"Clival chordoma with an atypical presentation: a case report","volume":"6","author":"Alshammari","year":"2012","unstructured":"Alshammari JMonnier PDaniel RTSandu K.Clival chordoma with an atypical presentation: a case report. J Med Case Rep. 2012;6:410."},{"issue":"4","key":"bib10","series-title":"Neurol Int","first-page":"1200","article-title":"An ecchordosis physaliphora, a rare entity, involving the central nervous system: a systematic review of the literature","volume":"15","author":"Gupta","year":"2023","unstructured":"Gupta RKReddy TAGupta ASamant RPerez CAHaque A.An ecchordosis physaliphora, a rare entity, involving the central nervous system: a systematic review of the literature. Neurol Int. 2023;15(4):1200-1211."},{"key":"bib11","series-title":"World Neurosurg","first-page":"e48","article-title":"Clinical and radiologic follow-up in ecchordosis physaliphora: a case series and literature review","volume":"191","author":"G\u00f6ko\u011flu","year":"2024","unstructured":"G\u00f6ko\u011flu ADo\u011fan SOruno\u011flu M\u00d6zt\u00fcrk MSel\u00e7uklu A.Clinical and radiologic follow-up in ecchordosis physaliphora: a case series and literature review. World Neurosurg. 2024;191:e48-e61."},{"issue":"5","key":"bib12","series-title":"Neurosurg Focus","first-page":"E2","article-title":"A watch, wait, and rescan approach for incidental benign-appearing notochordal lesions of the skull base","volume":"56","author":"Usher","year":"2024","unstructured":"Usher IEDrosos EMorsy AA watch, wait, and rescan approach for incidental benign-appearing notochordal lesions of the skull base. Neurosurg Focus. 2024;56(5):E2."},{"issue":"6","key":"bib13","series-title":"Skull Base","first-page":"395","article-title":"Cerebrospinal fluid rhinorrhea secondary to ecchordosis physaliphora","volume":"18","author":"Alli","year":"2008","unstructured":"Alli AClark MMansell NJ.Cerebrospinal fluid rhinorrhea secondary to ecchordosis physaliphora. Skull Base. 2008;18(6):395-399."},{"issue":"6","key":"bib14","series-title":"Laryngoscope","first-page":"1325","article-title":"Transnasal endoscopic resection of symptomatic ecchordosis physaliphora","volume":"124","author":"Bolzoni-Villaret","year":"2014","unstructured":"Bolzoni-Villaret AStefini RFontanella MTransnasal endoscopic resection of symptomatic ecchordosis physaliphora. Laryngoscope. 2014;124(6):1325-1328."},{"key":"bib15","series-title":"World Neurosurg","first-page":"85","article-title":"Spontaneous, intrasphenoidal rupture of ecchordosis physaliphora with pneumocephalus captured during serial imaging and clinical follow-up: pathoanatomic features and management","volume":"141","author":"Derakhshani","year":"2020","unstructured":"Derakhshani ALivingston SWilliam CSpontaneous, intrasphenoidal rupture of ecchordosis physaliphora with pneumocephalus captured during serial imaging and clinical follow-up: pathoanatomic features and management. World Neurosurg. 2020;141:85-90."},{"key":"bib16","series-title":"Clin Neurol Neurosurg","first-page":"116","article-title":"Successful endoscopic endonasal management of a transclival cerebrospinal fluid fistula secondary to ecchordosis physaliphora\u2014an ectopic remnant of primitive notochord tissue in the clivus","volume":"117","author":"Dias","year":"2014","unstructured":"Dias LANakanishi MMangussi-Gomes JCanuto MTakano GOliveira CA.Successful endoscopic endonasal management of a transclival cerebrospinal fluid fistula secondary to ecchordosis physaliphora\u2014an ectopic remnant of primitive notochord tissue in the clivus. Clin Neurol Neurosurg. 2014;117:116-119."},{"issue":"1","key":"bib17","series-title":"Can J Neurol Sci","first-page":"210","article-title":"A case study of symptomatic retroclival ecchordosis physaliphora: CT and MR imaging","volume":"43","author":"Ferguson","year":"2016","unstructured":"Ferguson CClarke DBSinha NShankar JJS.A case study of symptomatic retroclival ecchordosis physaliphora: CT and MR imaging. Can J Neurol Sci. 2016;43(1):210-212."},{"issue":"1","key":"bib18","series-title":"Br J Neurosurg","first-page":"99","article-title":"Spontaneous cerebrospinal fluid rhinorrhoea with meningitis secondary to ecchordosis physaliphora","volume":"33","author":"Galloway","year":"2019","unstructured":"Galloway LHayhurst C.Spontaneous cerebrospinal fluid rhinorrhoea with meningitis secondary to ecchordosis physaliphora. Br J Neurosurg. 2019;33(1):99-100."},{"issue":"1","key":"bib19","series-title":"J Laryngol Otol","first-page":"46","article-title":"Ecchordosis physaliphora: a cautionary tale","volume":"134","author":"Georgalas","year":"2020","unstructured":"Georgalas CTerzakis DTsikna MEcchordosis physaliphora: a cautionary tale. J Laryngol Otol. 2020;134(1):46-51."},{"issue":"3","key":"bib20","series-title":"Neurosurgery","first-page":"515","article-title":"Cerebrospinal fluid fistula secondary to ecchordosis physaliphora","volume":"26","author":"Macdonald","year":"1990","unstructured":"Macdonald RLCusimano MDDeck JHGullane PJDolan EJ.Cerebrospinal fluid fistula secondary to ecchordosis physaliphora. Neurosurgery. 1990;26(3):515-518."},{"issue":"13","key":"bib21","series-title":"J Neurosurg Case Lessons","first-page":"CASE236","article-title":"Spontaneous rhinorrhea: a possible concealing initial symptom of ecchordosis physaliphora. Illustrative case","volume":"5","author":"Castello Ruiz","year":"2023","unstructured":"Castello Ruiz MJAlsavaf MBFadel MSpontaneous rhinorrhea: a possible concealing initial symptom of ecchordosis physaliphora. Illustrative case. J Neurosurg Case Lessons. 2023;5(13):CASE236."},{"issue":"suppl 2","key":"bib22","series-title":"J Neurol Surg B Skull Base","first-page":"e96","article-title":"Do all notochordal lesions require proton beam radiotherapy? A proposed reclassification of ecchordosis physaliphora as benign notochord cell tumor","volume":"83","author":"Sooltangos","year":"2022","unstructured":"Sooltangos ABodi IGhimire PDo all notochordal lesions require proton beam radiotherapy? A proposed reclassification of ecchordosis physaliphora as benign notochord cell tumor. J Neurol Surg B Skull Base. 2022;83(suppl 2):e96-e104."},{"issue":"9","key":"bib23","series-title":"Acta Neurochir (Wien)","first-page":"2475","article-title":"Symptomatic ecchordosis physaliphora of the upper clivus: an exceedingly rare entity","volume":"163","author":"Veiceschi","year":"2021","unstructured":"Veiceschi PArosio ADAgosti ESymptomatic ecchordosis physaliphora of the upper clivus: an exceedingly rare entity. Acta Neurochir (Wien). 2021;163(9):2475-2486."},{"key":"bib24","series-title":"Clin Neurol Neurosurg","first-page":"107562","article-title":"Unrecognized notochordal lesions as a likely cause of idiopathic clival cerebrospinal fluid leaks","volume":"224","author":"Hasegawa","year":"2023","unstructured":"Hasegawa HVan Gompel JJChoby GRaghunathan ALittle JTAtkinson JL.Unrecognized notochordal lesions as a likely cause of idiopathic clival cerebrospinal fluid leaks. Clin Neurol Neurosurg. 2023;224:107562."},{"issue":"3","key":"bib1","series-title":"Arch Pathol Lab Med","first-page":"386","article-title":"Chordoma","volume":"146","author":"Ulici","year":"2022","unstructured":"Ulici VHart J.Chordoma. Arch Pathol Lab Med. 2022;146(3):386-395."},{"issue":"9","key":"bib2","series-title":"J Neurosurg Case Lessons","first-page":"CASE23177","article-title":"A rare case of multifocal chordoma involving the lower clivus and multiple spine levels: illustrative case","volume":"6","author":"Alsavaf","year":"2023","unstructured":"Alsavaf MBSalem EHJawad BAMongkolkul KCarrau RLPrevedello DM.A rare case of multifocal chordoma involving the lower clivus and multiple spine levels: illustrative case. J Neurosurg Case Lessons. 2023;6(9):CASE23177."},{"issue":"8","key":"bib3","series-title":"J Clin Neurosci","first-page":"1083","article-title":"Transclival cerebrospinal fluid rhinorrhea as the initial presenting symptom of a tiny intradural chordoma","volume":"17","author":"Feng","year":"2010","unstructured":"Feng KQiuhang ZQiuyi Q.Transclival cerebrospinal fluid rhinorrhea as the initial presenting symptom of a tiny intradural chordoma. J Clin Neurosci. 2010;17(8):1083-1085."},{"issue":"7","key":"bib4","series-title":"No Shinkei Geka","first-page":"601","article-title":"A case report of clivus chordoma presenting with cerebrospinal fluid rhinorrhea","volume":"48","author":"Ujikawa","year":"2020","unstructured":"Ujikawa TTanaka YOnaka KA case report of clivus chordoma presenting with cerebrospinal fluid rhinorrhea. No Shinkei Geka. 2020;48(7):601-606."},{"issue":"4","key":"bib5","series-title":"Surg Neurol","first-page":"331","article-title":"Endonasal microscopic removal of clival chordomas","volume":"69","author":"Fatemi","year":"2008","unstructured":"Fatemi NDusick JRGorgulho AAEndonasal microscopic removal of clival chordomas. Surg Neurol. 2008;69(4):331-338."},{"issue":"14","key":"bib6","series-title":"J Neurosurg Case Lessons","first-page":"CASE2347","article-title":"Chronic cerebrospinal fluid rhinorrhea as an initial presentation of chordoma: illustrative case","volume":"5","author":"Prather","year":"2023","unstructured":"Prather KYShi HHMcKinney KADunn IF.Chronic cerebrospinal fluid rhinorrhea as an initial presentation of chordoma: illustrative case. J Neurosurg Case Lessons. 2023;5(14):CASE2347."},{"issue":"5","key":"bib7","series-title":"Rinsho Shinkeigaku","first-page":"264","article-title":"A case of chordoma presenting as recurrent bacterial meningitis with cerebrospinal fluid leakage","volume":"59","author":"Ando","year":"2019","unstructured":"Ando SUsuda HUmeda YUmeda MOyake MFujita N.A case of chordoma presenting as recurrent bacterial meningitis with cerebrospinal fluid leakage. Rinsho Shinkeigaku. 2019;59(5):264-267."},{"issue":"4","key":"bib8","series-title":"Neurol India","first-page":"513","article-title":"Spontaneous cerebrospinal fluid rhinorrhea: a rare initial presentation of clival chordoma","volume":"57","author":"Hsieh","year":"2009","unstructured":"Hsieh CTLiu MYSu WFJu DT.Spontaneous cerebrospinal fluid rhinorrhea: a rare initial presentation of clival chordoma. Neurol India. 2009;57(4):513-514."},{"key":"bib9","series-title":"J Med Case Rep","first-page":"410.","article-title":"Clival chordoma with an atypical presentation: a case report","volume":"6","author":"Alshammari","year":"2012","unstructured":"Alshammari JMonnier PDaniel RTSandu K.Clival chordoma with an atypical presentation: a case report. J Med Case Rep. 2012;6:410."},{"issue":"4","key":"bib10","series-title":"Neurol Int","first-page":"1200","article-title":"An ecchordosis physaliphora, a rare entity, involving the central nervous system: a systematic review of the literature","volume":"15","author":"Gupta","year":"2023","unstructured":"Gupta RKReddy TAGupta ASamant RPerez CAHaque A.An ecchordosis physaliphora, a rare entity, involving the central nervous system: a systematic review of the literature. Neurol Int. 2023;15(4):1200-1211."},{"key":"bib11","series-title":"World Neurosurg","first-page":"e48","article-title":"Clinical and radiologic follow-up in ecchordosis physaliphora: a case series and literature review","volume":"191","author":"G\u00f6ko\u011flu","year":"2024","unstructured":"G\u00f6ko\u011flu ADo\u011fan SOruno\u011flu M\u00d6zt\u00fcrk MSel\u00e7uklu A.Clinical and radiologic follow-up in ecchordosis physaliphora: a case series and literature review. World Neurosurg. 2024;191:e48-e61."},{"issue":"5","key":"bib12","series-title":"Neurosurg Focus","first-page":"E2","article-title":"A watch, wait, and rescan approach for incidental benign-appearing notochordal lesions of the skull base","volume":"56","author":"Usher","year":"2024","unstructured":"Usher IEDrosos EMorsy AA watch, wait, and rescan approach for incidental benign-appearing notochordal lesions of the skull base. Neurosurg Focus. 2024;56(5):E2."},{"issue":"6","key":"bib13","series-title":"Skull Base","first-page":"395","article-title":"Cerebrospinal fluid rhinorrhea secondary to ecchordosis physaliphora","volume":"18","author":"Alli","year":"2008","unstructured":"Alli AClark MMansell NJ.Cerebrospinal fluid rhinorrhea secondary to ecchordosis physaliphora. Skull Base. 2008;18(6):395-399."},{"issue":"6","key":"bib14","series-title":"Laryngoscope","first-page":"1325","article-title":"Transnasal endoscopic resection of symptomatic ecchordosis physaliphora","volume":"124","author":"Bolzoni-Villaret","year":"2014","unstructured":"Bolzoni-Villaret AStefini RFontanella MTransnasal endoscopic resection of symptomatic ecchordosis physaliphora. Laryngoscope. 2014;124(6):1325-1328."},{"key":"bib15","series-title":"World Neurosurg","first-page":"85","article-title":"Spontaneous, intrasphenoidal rupture of ecchordosis physaliphora with pneumocephalus captured during serial imaging and clinical follow-up: pathoanatomic features and management","volume":"141","author":"Derakhshani","year":"2020","unstructured":"Derakhshani ALivingston SWilliam CSpontaneous, intrasphenoidal rupture of ecchordosis physaliphora with pneumocephalus captured during serial imaging and clinical follow-up: pathoanatomic features and management. World Neurosurg. 2020;141:85-90."},{"key":"bib16","series-title":"Clin Neurol Neurosurg","first-page":"116","article-title":"Successful endoscopic endonasal management of a transclival cerebrospinal fluid fistula secondary to ecchordosis physaliphora\u2014an ectopic remnant of primitive notochord tissue in the clivus","volume":"117","author":"Dias","year":"2014","unstructured":"Dias LANakanishi MMangussi-Gomes JCanuto MTakano GOliveira CA.Successful endoscopic endonasal management of a transclival cerebrospinal fluid fistula secondary to ecchordosis physaliphora\u2014an ectopic remnant of primitive notochord tissue in the clivus. Clin Neurol Neurosurg. 2014;117:116-119."},{"issue":"1","key":"bib17","series-title":"Can J Neurol Sci","first-page":"210","article-title":"A case study of symptomatic retroclival ecchordosis physaliphora: CT and MR imaging","volume":"43","author":"Ferguson","year":"2016","unstructured":"Ferguson CClarke DBSinha NShankar JJS.A case study of symptomatic retroclival ecchordosis physaliphora: CT and MR imaging. Can J Neurol Sci. 2016;43(1):210-212."},{"issue":"1","key":"bib18","series-title":"Br J Neurosurg","first-page":"99","article-title":"Spontaneous cerebrospinal fluid rhinorrhoea with meningitis secondary to ecchordosis physaliphora","volume":"33","author":"Galloway","year":"2019","unstructured":"Galloway LHayhurst C.Spontaneous cerebrospinal fluid rhinorrhoea with meningitis secondary to ecchordosis physaliphora. Br J Neurosurg. 2019;33(1):99-100."},{"issue":"1","key":"bib19","series-title":"J Laryngol Otol","first-page":"46","article-title":"Ecchordosis physaliphora: a cautionary tale","volume":"134","author":"Georgalas","year":"2020","unstructured":"Georgalas CTerzakis DTsikna MEcchordosis physaliphora: a cautionary tale. J Laryngol Otol. 2020;134(1):46-51."},{"issue":"3","key":"bib20","series-title":"Neurosurgery","first-page":"515","article-title":"Cerebrospinal fluid fistula secondary to ecchordosis physaliphora","volume":"26","author":"Macdonald","year":"1990","unstructured":"Macdonald RLCusimano MDDeck JHGullane PJDolan EJ.Cerebrospinal fluid fistula secondary to ecchordosis physaliphora. Neurosurgery. 1990;26(3):515-518."},{"issue":"13","key":"bib21","series-title":"J Neurosurg Case Lessons","first-page":"CASE236","article-title":"Spontaneous rhinorrhea: a possible concealing initial symptom of ecchordosis physaliphora. Illustrative case","volume":"5","author":"Castello Ruiz","year":"2023","unstructured":"Castello Ruiz MJAlsavaf MBFadel MSpontaneous rhinorrhea: a possible concealing initial symptom of ecchordosis physaliphora. Illustrative case. J Neurosurg Case Lessons. 2023;5(13):CASE236."},{"issue":"suppl 2","key":"bib22","series-title":"J Neurol Surg B Skull Base","first-page":"e96","article-title":"Do all notochordal lesions require proton beam radiotherapy? A proposed reclassification of ecchordosis physaliphora as benign notochord cell tumor","volume":"83","author":"Sooltangos","year":"2022","unstructured":"Sooltangos ABodi IGhimire PDo all notochordal lesions require proton beam radiotherapy? A proposed reclassification of ecchordosis physaliphora as benign notochord cell tumor. J Neurol Surg B Skull Base. 2022;83(suppl 2):e96-e104."},{"issue":"9","key":"bib23","series-title":"Acta Neurochir (Wien)","first-page":"2475","article-title":"Symptomatic ecchordosis physaliphora of the upper clivus: an exceedingly rare entity","volume":"163","author":"Veiceschi","year":"2021","unstructured":"Veiceschi PArosio ADAgosti ESymptomatic ecchordosis physaliphora of the upper clivus: an exceedingly rare entity. Acta Neurochir (Wien). 2021;163(9):2475-2486."},{"key":"bib24","series-title":"Clin Neurol Neurosurg","first-page":"107562","article-title":"Unrecognized notochordal lesions as a likely cause of idiopathic clival cerebrospinal fluid leaks","volume":"224","author":"Hasegawa","year":"2023","unstructured":"Hasegawa HVan Gompel JJChoby GRaghunathan ALittle JTAtkinson JL.Unrecognized notochordal lesions as a likely cause of idiopathic clival cerebrospinal fluid leaks. Clin Neurol Neurosurg. 2023;224:107562."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/22\/article-CASE25157.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/22\/article-CASE25157.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/22\/article-CASE25157.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T23:37:27Z","timestamp":1770075447000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/22\/article-CASE25157.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,2]]},"references-count":48,"journal-issue":{"issue":"22"},"URL":"https:\/\/doi.org\/10.3171\/case25157","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,2]]}}}