{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:45:02Z","timestamp":1782920702621,"version":"3.54.5"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017695","name":"Health Commission of Hunan Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017695","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019054","name":"Changsha Science and Technology Project","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100019054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cerebrospinal fluid (CSF) rhinorrhea most frequently results from traumatic or iatrogenic skull base disruption. In contrast, tumor-induced spontaneous CSF leaks and the subsequent development of purulent meningitis (PM) are relatively rare and pose significant diagnostic challenges.<\/jats:p>\n                    <jats:p>Case Presentation: A 39-year-old man presented with acute headache and fever following a two-month history of intermittent, clear unilateral rhinorrhea. Lumbar puncture confirmed PM, and brain magnetic resonance imaging (MRI) revealed left lateral ventricular empyema but no definitive skull-base mass. After achieving clinical stability with a two-week course of targeted antibiotics, the patient underwent endoscopic CSF fistula repair. Intraoperatively, a clival lesion was encountered; histopathological examination (characterized by physaliferous cells and brachyury positivity) confirmed the diagnosis of chordoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case suggests that persistent spontaneous CSF rhinorrhea can be the initial manifestation of an occult skull-base tumor, even in the absence of clear findings on preoperative MRI. In patients with CSF leak complicated by meningitis, management must prioritize infection control while concurrently pursuing a thorough etiologic workup and timely surgical intervention to address both the fistula and any underlying neoplasm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1870757","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:52:03Z","timestamp":1782917523000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Occult clival chordoma initially unrecognized on MRI presenting with cerebrospinal fluid rhinorrhea: a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Sufen","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Neurology, Liuyang Jili Hospital","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzhang","family":"Bei","sequence":"additional","affiliation":[{"name":"Department of Neurology, Liuyang Jili Hospital","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifeng","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Liuyang Jili Hospital","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Su","sequence":"additional","affiliation":[{"name":"NeuroMedical Center, The Second Affiliated Hospital of University of South China","place":["Hengyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengqiang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine (The Affiliated Hospital of Hunan Academy of Traditional Chinese 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