Kanaan I, Ahmed M, Rifai A, Alwatban J
Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Neurosurgery. 1998 Jun;42(6):1374-7. doi: 10.1097/00006123-199806000-00113.
Brown tumor is a misnomer for a reparative cellular process caused by primary or, less commonly, secondary or tertiary hyperparathyroidism. Atypical involvement of the base of the cranium in the area of the sphenoid sinus and the orbit is exceedingly rare and may produce a neurological deficit as a primary clinical presentation. Those neurosurgeons dealing with cranial base and pituitary lesions should be aware of this disease entity, and it should be listed in the differential diagnosis.
A 21-year-old woman with end-stage renal failure on chronic dialysis was referred to the Department of Neurosciences at King Faisal Specialist Hospital and Research Centre with a 4-month history of progressive impairment of vision, associated with headache and nausea. Computed tomography and magnetic resonance imaging demonstrated an expansive mass lesion in the sphenoid sinus with erosion of the sellar floor and posterior medial wall of the orbit causing compression of the optic nerves. The biochemical laboratory studies showed elevation of parathyroid hormone and confirmed the diagnosis of hyperparathyroidism.
The transnasal-transsphenoidal approach was used for extensive microsurgical removal of the lesion. The postoperative course was uneventful, and the improvement in vision was dramatic.
Brown tumor, although rare, should be listed in the differential diagnosis of expansive mass lesions in the area of the sphenoid sinus and cranial base. The management is multidisciplinary, and therapeutic options should target the underlying cause.
棕色瘤是由原发性甲状旁腺功能亢进引起的修复性细胞过程的误称，继发性或三发性甲状旁腺功能亢进引起者则较为少见。蝶窦和眼眶区域颅底的非典型受累极为罕见，可能以神经功能缺损作为主要临床表现。处理颅底和垂体病变的神经外科医生应了解这种疾病实体，并应将其列入鉴别诊断。
一名21岁慢性透析终末期肾衰竭女性，因视力进行性减退4个月，伴有头痛和恶心，被转诊至法赫德国王专科医院和研究中心神经科学部。计算机断层扫描和磁共振成像显示蝶窦内有一占位性病变，蝶鞍底和眶后内侧壁侵蚀，导致视神经受压。生化实验室检查显示甲状旁腺激素升高，确诊为甲状旁腺功能亢进。
采用经鼻-蝶窦入路进行广泛的显微手术切除病变。术后过程顺利，视力改善显著。
棕色瘤虽罕见，但应列入蝶窦和颅底区域占位性病变的鉴别诊断。治疗是多学科的，治疗选择应针对潜在病因。
