• Omar Choudhri, Abdullah Feroze, Peter Hwang, Hannes Vogel, Abdulrazag Ajlan, and Griffith Harsh.
• Department of Neurosurgery, Division of Neuropathology, Stanford University School of Medicine, Stanford, California, USA.
• World Neurosurg. 2014 Nov 1;82(5):912.e21-6.

ObjectiveTo report the first complete resection of a giant ecchordosis physaliphora using an endoscopic transclival approach and to provide a current review of the literature.MethodsThis rare benign lesion, originating from embryonic notochordal remnants, was located in the prepontine cistern of a 63-year-old man presenting with progressive tremor and imbalance. Preoperative imaging demonstrated a 2.1-cm intradural lesion abutting the pons and basilar artery and extending through the dura mater.ResultsA gross total resection was successfully achieved endoscopically without neurovascular compromise or additional complications. Postoperative histopathologic examination was consistent with a diagnosis of giant ecchordosis physaliphora.ConclusionsAn endoscopic endonasal transclival approach provided a direct, minimally invasive route for safe and complete resection of this rare prepontine tumor, as it has for similarly located skull base chordomas. Our experience highlights the utility of endoscopy in visualization of both pathologic entities and nearby critical neurovascular structures in the management of ecchordosis physaliphora and other cranial base neoplasms.Copyright © 2014 Elsevier Inc. All rights reserved.

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