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[鞍区碰撞肿瘤:术前神经影像学检查的难点及手术入路的选择。病例报告及文献综述]

[Sellar collision tumors: difficulties of preoperative neuroimaging and selection of surgical approach. Case reports and literature review].

作者信息

Kurnukhina M Yu, Cherebillo V Yu, Gavrilov G V, Grachev V A

机构信息

Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia.

出版信息

Zh Vopr Neirokhir Im N N Burdenko. 2025;89(3):75-82. doi: 10.17116/neiro20258903175.

Abstract

Sellar tumors are predominantly benign neoplasms accounting for approximately 14-18% of all brain tumors. For many decades, there have been a few clinical cases confirming possible simultaneous coexistence of two nosological groups in one area. We present 2 rare cases of sellar collision tumors (a 61-year-old male with pituitary adenoma and craniopharyngioma; a 68-year-old female with pituitary adenoma and meningioma of tubercle), clinical features, anamnesis, preoperative neuroimaging, intraoperative picture and postoperative outcomes. Combination of pituitary adenoma and craniopharyngioma/ meningioma as a type of collision tumors requires caution at all stages of treatment due to impossible preoperative analysis of tumor density and, accordingly, correct choice of surgical access. Transsphenoidal endoscopic access reduces mortality rate according to literature data. Preoperative MR elastometry needs to be studied in depth including patients with sellar collision tumors.

摘要

鞍区肿瘤主要是良性肿瘤,约占所有脑肿瘤的14 - 18%。几十年来,已有一些临床病例证实一个区域可能同时存在两种疾病类型。我们报告2例罕见的鞍区碰撞肿瘤病例(1例61岁男性患有垂体腺瘤和颅咽管瘤;1例68岁女性患有垂体腺瘤和结节部脑膜瘤),包括临床特征、病史、术前神经影像学检查、术中情况及术后结果。垂体腺瘤与颅咽管瘤/脑膜瘤组合作为一种碰撞肿瘤,由于术前无法分析肿瘤密度,因此在治疗的各个阶段都需要谨慎,从而正确选择手术入路。根据文献数据,经蝶窦内镜入路可降低死亡率。需要深入研究术前磁共振弹性成像,包括鞍区碰撞肿瘤患者。

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