Intrasellar Chordoma Mimicking Pituitary Macroadenoma with Hyperprolactinemia and Hypopituitarism: Clinical Images with a Surgical Video
Intrasellar Chordoma Mimicking Pituitary Macroadenoma with Hyperprolactinemia and Hypopituitarism: Clinical Images with a Surgical Video
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DOI：
10.1016/j.wneu.2022.11.031
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发表时间：
2023-02-09
影响因子：
2
通讯作者：
Sasayama, Takashi
中科院分区：
文献类型：
--
作者：
Fujita, Yuichi;Uozumi, Yoichi;Sasayama, Takashi
单纯的鞍内脊索瘤在颅底脊索瘤中很少见，通常认为起源于蝶鞍内的异位胚胎脊索。由于其罕见及无特异性的症状，临床医师根据术前影像学检查可能会将其误诊为垂体腺瘤。在这份报告中，我们提出了一个鞍内脉络膜，临床上模仿垂体大腺瘤高泌乳素血症和垂体功能减退症，并成功地切除了内窥镜经鼻经蝶手术。本病例的影像学特征显示鞍区病变应怀疑脉络膜。鞍区增大伴骨质变薄，斜坡无破坏，首先提示垂体腺瘤，而T2加权像上的高信号和不均匀强化则提示脉络膜增生。在鞍区病变的术前评估中必须考虑这种罕见的诊断，因为它会影响神经外科医生如何准备手术和手术目标。
A purely intrasellar chordoma is rare among skull base chordomas and is recognized as originating from ectopic embryological notochord located in the sella turcica. In view of its rarity and nonspecific symptoms, clinicians may misdiagnose intrasellar chordoma as pituitary adenoma based on preoperative radiographic images. In this report, we present an intrasellar chordoma that clinically mimicked pituitary macroadenoma with hyperprolactinemia and hy-popituitarism and was successfully resected by endoscopic endonasal trans-sphenoidal surgery. This case demonstrated radiographic features that chordoma should be suspected in sellar lesions. The enlarged sellar with thinned remodeled bone without clival destruction was firstly reminiscent of pituitary adenoma, whereas the very high signal on T2-weighted images and heterogeneous enhancement characteristically suggested chordoma. This rare diagnosis must be considered in the preoperative evaluation of sellar lesions because it can affect how the neurosurgeon prepares for surgery and the sur-gical goals.