颅底脊索瘤的影像学诊断及治疗研究（附26例报告）

目的：探讨颅底脊索瘤的CT、MRI表现及治疗措施。方法：回顾性分析经病理证实的26例脊索瘤患者的临床资料。肿瘤位于鞍区及鼻咽部者9例，位于中颅窝者5例，位于后颅窝者8例，混合型4例。手术入路：额颞入路一翼点开颅9例，鼻内镜下经蝶入路5例，颞下、颞枕及扩大中颅窝入路8例，4例未手术行放射治疗。结果：肿瘤全切8例，大部及次全切14例，围手术期未见死亡病例。25例患者获得随访；3例于术后1年内复发，其中2例死亡，余者颅神经损伤及肢体症状均有改善。结论：脊索瘤无典型临床表现，现多可通过术前影像学检查得以诊断，少数位于特殊位置者需与垂体瘤，颅咽管瘤，三叉神经鞘瘤等鉴别；肿瘤全切较为困难，根据需要选择相应的手术入路可明显提高手术效果；放疗可作为术后辅助治疗。

Skull Base Chordoma： CT/MRI Findings and Treatment of 26 Patients

Objective： To investigate the CT/MRI and treatment of skull base chordoma. Methods： The clinical data of 26 patients who had pathologically confirmed intracranial chordroma treated at our hospital were retrospectively analyzed. Location of tumor：9 cases were in sellar and nasopharyngeal region, 5 in middle cranial fossa, 8 cases were in posterior cranial fossa, 4 cases were performanced diffuse growth. Surgical approach： 9 patients underwent operation via frontal-temporal pterional approach, 5 patients underwent operation via transsphenoidal approach using endoscope, 8 patients underwent operation via subtemporal, occipitotemporal or extended middle fossa approach, 4 cases underwent radiotherapy. Results： Total resection was achieved in 8 patients, subtotal and partial resections in 14 patients, and there was no perioperative mortality. 25 patients were followed up postoperatively for a mean duration of 2.5 years, 22 patients recovered without recurrences, three patients had recurrence, two patients died. Conclusion： Although there were no typical signs and symptoms of chordoma, the disease could be accurately diagnosed before surgery by imaging. In some cases, it should be identificated from hypophysoma, craniolpharyngioma or trigeminal schwanoma. Complete initial resection of tumor was very difficult, selecting appropriate surgical approach would helpful for the therapeutic effect. Adjuvant radiotherapy could also be used in selected patients.