{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:13Z","timestamp":1776096373785,"version":"3.50.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"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 Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"\n BACKGROUND<\/jats:title>\n Ecchordosis physaliphora (EP) is a rare notochordal remnant and the benign counterpart to chordomas with the same cell of origin. They are most commonly located intracranially along the posterior clivus in the prepontine cistern. EPs are typically discovered incidentally, but a small subset can present with symptoms, including a CSF leak. There are very few reported cases of EP-related meningitis, which occur after a short course of CSF leakage.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 48-year-old female with a history of clear rhinorrhea for several years presented with meningitis and a neurological decline. Neuroimaging identified a clival mass and associated bony defect between the sphenoid sinus and prepontine cistern. She was treated with antibiotics and CSF diversion via a lumbar drain. An endoscopic endonasal resection and skull base repair was performed after CSF sterilization. Neuropathological evaluation demonstrated an EP. She recovered to baseline and remains without a recurrent CSF leak or meningitis in outpatient follow-up.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This is the first case of long-standing rhinorrhea and presentation of meningitis from a clival lesion, and it is one of the few cases of EP-related meningitis. Early recognition and workup of CSF rhinorrhea is critical to avoid progression to meningitis, and EPs are a rare cause of this presentation.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25540<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25540","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T13:30:10Z","timestamp":1770298210000},"source":"Crossref","is-referenced-by-count":0,"title":["Ecchordosis physaliphora presenting with cerebrospinal fluid leak and meningitis: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7271-7022","authenticated-orcid":true,"given":"Kishore","family":"Balasubramanian","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"},{"name":"Texas A&M University College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey A.","family":"Zuccato","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4658-4967","authenticated-orcid":true,"given":"Edward","family":"El Rassi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0275-6736","authenticated-orcid":true,"given":"Ian F.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","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":"4","key":"bib2","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."},{"issue":"1","key":"bib3","series-title":"Neurosurg Rev","first-page":"87","article-title":"Ecchordosis physaliphora: typical and atypical radiologic features","volume":"40","author":"Park","year":"2017","unstructured":"Park HHLee KSAhn SJSuh SHHong CK.Ecchordosis physaliphora: typical and atypical radiologic features. Neurosurg Rev. 2017;40(1):87-94."},{"issue":"10","key":"bib4","series-title":"AJNR Am J Neuroradiol","first-page":"1851","article-title":"Retroclival ecchordosis physaliphora: MR imaging and review of the literature","volume":"25","author":"Mehnert","year":"2004","unstructured":"Mehnert FBeschorner RK\u00fcker WHahn UN\u00e4gele T.Retroclival ecchordosis physaliphora: MR imaging and review of the literature. AJNR Am J Neuroradiol. 2004;25(10):1851-1855."},{"issue":"4","key":"bib5","series-title":"Spine (Phila Pa 1976)","first-page":"493","article-title":"Chordoma of the mobile spine: fifty years of experience","volume":"31","author":"Boriani","year":"2006","unstructured":"Boriani SBandiera SBiagini RChordoma of the mobile spine: fifty years of experience. Spine (Phila Pa 1976). 2006;31(4):493-503."},{"issue":"11","key":"bib6","series-title":"Oncologist","first-page":"1344","article-title":"Chordoma: the nonsarcoma primary bone tumor","volume":"12","author":"Chugh","year":"2007","unstructured":"Chugh RTawbi HLucas DRBiermann JSSchuetze SMBaker LH.Chordoma: the nonsarcoma primary bone tumor. Oncologist. 2007;12(11):1344-1350."},{"issue":"1","key":"bib7","series-title":"Cancer Causes Control","first-page":"1","article-title":"Chordoma: incidence and survival patterns in the United States, 1973-1995","volume":"12","author":"McMaster","year":"2001","unstructured":"McMaster MLGoldstein AMBromley CMIshibe NParry DM.Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control. 2001;12(1):1-11."},{"issue":"11","key":"bib8","series-title":"Cancer","first-page":"2029","article-title":"Incidence and relative survival of chordomas: the standardized mortality ratio and the impact of chordomas on a population","volume":"119","author":"Smoll","year":"2013","unstructured":"Smoll NRGautschi OPRadovanovic ISchaller KWeber DC.Incidence and relative survival of chordomas: the standardized mortality ratio and the impact of chordomas on a population. Cancer. 2013;119(11):2029-2037."},{"issue":"13","key":"bib9","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":"9","key":"bib10","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."},{"issue":"14","key":"bib11","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":"2","key":"bib12","series-title":"J Neurol Surg Rep","first-page":"92","article-title":"Transclival pseudomeningocele secondary to ecchordosis physaliphora: case report and literature review","volume":"74","author":"Kaul","year":"2013","unstructured":"Kaul SKhan OHEdem ITransclival pseudomeningocele secondary to ecchordosis physaliphora: case report and literature review. J Neurol Surg Rep. 2013;74(2):92-95."},{"issue":"1","key":"bib13","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(1):410."},{"issue":"1","key":"bib14","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."},{"key":"bib15","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":"5","key":"bib16","series-title":"J Korean Neurosurg Soc","first-page":"403","article-title":"Extraordinarily long-term posttraumatic cerebrospinal fluid fistula","volume":"42","author":"Kim","year":"2007","unstructured":"Kim HSHur JWLee JWLee HK.Extraordinarily long-term posttraumatic cerebrospinal fluid fistula. J Korean Neurosurg Soc. 2007;42(5):403-405."},{"issue":"6","key":"bib17","series-title":"J Neurol Surg B Skull Base","first-page":"401","article-title":"The association of meningitis with postoperative cerebrospinal fluid fistula","volume":"73","author":"Allen","year":"2012","unstructured":"Allen KPIsaacson BKutz JWPurcell PLRoland PS.The association of meningitis with postoperative cerebrospinal fluid fistula. J Neurol Surg B Skull Base. 2012;73(6):401-404."},{"issue":"1","key":"bib1","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":"4","key":"bib2","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."},{"issue":"1","key":"bib3","series-title":"Neurosurg Rev","first-page":"87","article-title":"Ecchordosis physaliphora: typical and atypical radiologic features","volume":"40","author":"Park","year":"2017","unstructured":"Park HHLee KSAhn SJSuh SHHong CK.Ecchordosis physaliphora: typical and atypical radiologic features. Neurosurg Rev. 2017;40(1):87-94."},{"issue":"10","key":"bib4","series-title":"AJNR Am J Neuroradiol","first-page":"1851","article-title":"Retroclival ecchordosis physaliphora: MR imaging and review of the literature","volume":"25","author":"Mehnert","year":"2004","unstructured":"Mehnert FBeschorner RK\u00fcker WHahn UN\u00e4gele T.Retroclival ecchordosis physaliphora: MR imaging and review of the literature. AJNR Am J Neuroradiol. 2004;25(10):1851-1855."},{"issue":"4","key":"bib5","series-title":"Spine (Phila Pa 1976)","first-page":"493","article-title":"Chordoma of the mobile spine: fifty years of experience","volume":"31","author":"Boriani","year":"2006","unstructured":"Boriani SBandiera SBiagini RChordoma of the mobile spine: fifty years of experience. Spine (Phila Pa 1976). 2006;31(4):493-503."},{"issue":"11","key":"bib6","series-title":"Oncologist","first-page":"1344","article-title":"Chordoma: the nonsarcoma primary bone tumor","volume":"12","author":"Chugh","year":"2007","unstructured":"Chugh RTawbi HLucas DRBiermann JSSchuetze SMBaker LH.Chordoma: the nonsarcoma primary bone tumor. Oncologist. 2007;12(11):1344-1350."},{"issue":"1","key":"bib7","series-title":"Cancer Causes Control","first-page":"1","article-title":"Chordoma: incidence and survival patterns in the United States, 1973-1995","volume":"12","author":"McMaster","year":"2001","unstructured":"McMaster MLGoldstein AMBromley CMIshibe NParry DM.Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control. 2001;12(1):1-11."},{"issue":"11","key":"bib8","series-title":"Cancer","first-page":"2029","article-title":"Incidence and relative survival of chordomas: the standardized mortality ratio and the impact of chordomas on a population","volume":"119","author":"Smoll","year":"2013","unstructured":"Smoll NRGautschi OPRadovanovic ISchaller KWeber DC.Incidence and relative survival of chordomas: the standardized mortality ratio and the impact of chordomas on a population. Cancer. 2013;119(11):2029-2037."},{"issue":"13","key":"bib9","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":"9","key":"bib10","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."},{"issue":"14","key":"bib11","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":"2","key":"bib12","series-title":"J Neurol Surg Rep","first-page":"92","article-title":"Transclival pseudomeningocele secondary to ecchordosis physaliphora: case report and literature review","volume":"74","author":"Kaul","year":"2013","unstructured":"Kaul SKhan OHEdem ITransclival pseudomeningocele secondary to ecchordosis physaliphora: case report and literature review. J Neurol Surg Rep. 2013;74(2):92-95."},{"issue":"1","key":"bib13","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(1):410."},{"issue":"1","key":"bib14","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."},{"key":"bib15","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":"5","key":"bib16","series-title":"J Korean Neurosurg Soc","first-page":"403","article-title":"Extraordinarily long-term posttraumatic cerebrospinal fluid fistula","volume":"42","author":"Kim","year":"2007","unstructured":"Kim HSHur JWLee JWLee HK.Extraordinarily long-term posttraumatic cerebrospinal fluid fistula. J Korean Neurosurg Soc. 2007;42(5):403-405."},{"issue":"6","key":"bib17","series-title":"J Neurol Surg B Skull Base","first-page":"401","article-title":"The association of meningitis with postoperative cerebrospinal fluid fistula","volume":"73","author":"Allen","year":"2012","unstructured":"Allen KPIsaacson BKutz JWPurcell PLRoland PS.The association of meningitis with postoperative cerebrospinal fluid fistula. 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