侵及鞍底鞍旁及斜坡的蝶窦脊索瘤1例

Chordoma originated from sphenoid sinus,encroach on sella,metasella and clivus:one case report

患者，男，58岁，主因“左眼视力下降伴肿胀感6d”入院。入院后查体：见左侧眼睑轻度下垂，上抬无力，角膜反射正常。其余全身检查未见异常。鼻咽镜检查示：鼻咽部未见新生物。鼻咽部增强CT示：鞍区可见不规则软组织密度影。平扫、动脉期、静脉期和延迟期CT值分别为30、41、44和44HU，病变向上生长，突破鞍膈，向下生长，局部凸向蝶窦左侧分隔，蝶窦及后床突受压致骨质变薄，局部骨质吸收；双侧海绵窦未见明显受压；诸脑室、脑池系统轻度扩张；中线结构居中，无偏移。MRI检查示：左侧蝶窦、鞍区及枕骨斜坡交界处可见类圆形异常信号影（图1），T1WI低，T2WI略高信号，矢状位病变范围约2．2cm×2．8cm，边界较清，信号不均匀；病变主体位于蝶窦内，肿物向上生长，鞍底及部分枕骨斜坡骨质吸收改变；左侧颈内动脉可见包埋征象，鞍区扩大。术前垂体激素系列检查未见异常。左眼视力下降，视野下方缺损。术前诊断为左侧蝶窦肿物和鼻中隔偏曲。

The purpose is to report a case of chordoma, which orignated from sphenoid sinus and encroach on sella, metasella and clivus. We comprehensively analyzed the CT and MRI information and diffrentiated the ill- nessfrom the commonly encountered diseases of sphenoid sinus and sellato improve the accuracy before surgery.