Ragel B T, Bishop F S, Couldwell W T
Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
Acta Neurochir (Wien). 2007;149(7):729-30; discussion 730. doi: 10.1007/s00701-007-1168-3. Epub 2007 May 30.
The patient is a 44-year-old man who underwent resection of a posterior nasopharynx tumor 12 years earlier via left lateral rhinotomy approach. The final pathological analysis indicated the tumor was a craniopharyngioma, and the patient subsequently underwent focal radiation. The patient returned to medical attention complaining of dysequilibrium. A neurologic exam was nonfocal. Magnetic resonance imaging revealed a clival mass, separate from the sella turcica, with imaging characteristics concerning for chordoma or primary bone tumor (Fig. 1). The lesion was resected via an endoscope-assisted endonasal transsphenoidal approach, with gross total resection achieved. Intraoperatively, the mass was noted to erode through the posterior nasopharynx, without extension superiorly into the sella or posteriorly through the clival dura (i.e., lesion was infrasellar). The final pathological results indicated the tumor was adamantinomatous craniopharyngioma.
该患者为一名44岁男性，12年前经左侧鼻侧切开术切除鼻咽部后方肿瘤。最终病理分析显示肿瘤为颅咽管瘤，患者随后接受了局部放疗。患者因平衡失调前来就医。神经系统检查未发现局灶性病变。磁共振成像显示斜坡有一肿块，与蝶鞍分开，其影像学特征提示为脊索瘤或原发性骨肿瘤（图1）。通过内镜辅助鼻内经蝶窦入路切除病变，实现了大体全切。术中发现肿块侵蚀鼻咽部后方，未向上延伸至蝶鞍或向后穿过斜坡硬脑膜（即病变位于鞍下）。最终病理结果显示肿瘤为造釉细胞型颅咽管瘤。
