Posterior communicating artery aneurysm associated with duplicated posterior communicating artery and bilateral fetal posterior cerebral arteries.

Because of the location, skull-base chordomas often present with headaches and diplopia and sixth and fifth nerve palsies are the most common neurological signs.[1,2] The interval between onset of symptoms and diagnosis of clival chordoma is quite variable, 2.5-4.4 years.[4] The uncommon clinical presentations include: Nasal obstruction, nasal bleeding, and subarachnoid hemorrhage.[3,5] Spontaneous CSF rhinorrhea without neurological deficits as the initially manifestation of clival chordoma has rarely been reported. In one report of 14 patients with clival chordomas, two patients presented with spontaneous CSF rhinorrhea. [1] However, in this report the authors had not detailed the clinical characteristics of the two patients. In cases of spontaneous CSF leak, high-resolution CT scanning is the best investigative modality to evaluate the detail of bony structures of parasinus walls and skull base. MRI is helpful to investigate the soft tissue and possible site of leak. With the advance of microscopic and endoscopic techniques, endonasal trans-sphenoidal method is the best method to prove the diagnosis and also to repair the leak.[1]