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本文报导了一例CT难于诊断的颅咽管瘤。患者：男性，47岁，因间歇性头痛一年多，双眼视力减退年以上，于1992－06月入院诊治。一年前患者出现前额部隐痛，进行性加剧，半年后出现双眼视力减退的症状。曾作两次CT扫描，均未发现异常，诊断为球后视神经炎，予激素治疗40天后，双眼视力复原，头痛缓解，以后症状反复发作三次，均用激素治疗缓解。1992年再次头颅CT冠状扫描诊为鞍区病变，检查：视力右1．0，左0．4，双颞侧偏盲，眼底无水肿，眼球运动不受限，神经系统检查无特殊发现。手术发现双侧视N受压，其中间有兰色肿物予以切除，病理报告为颅咽管瘤。术后视力恢复，一月后视力再次下降，双颞侧偏盲。CT扫描未发现肿瘤复发，再次手术发现视交叉前间隙有兰色肿物，周围严重粘连，肿瘤部分囊变，有钙化，分块切除肿瘤，松解视N粘连。术后14天复查视力布0．9，左0．8．21天后双眼视力开始下降，视力维持右0．4，左0．2，复查CT无肿瘤复发。视力迅速恶化的原因可能和视N再发生粘连。影响视N血供有关。
This article reports a case of craniopharyngioma difficult to diagnose by CT. Patients: Male, 47 years old, with intermittent headache more than a year, binocular vision loss more than years, admitted to hospital in 1992-06. A year ago patients with forehead pain, progressive increase, six months after the symptoms of binocular vision loss. Had made two CT scans, were found no abnormalities, diagnosed as retrobulbar neuritis, hormone treatment for 40 days, binocular vision restoration, headache relief, symptoms after repeated attacks three times, were treated with hormone therapy. Again in 1992 CT scan of the head as a diagnosis of saddle area lesions, check: visual acuity 1.0, left 0.4, bilateral temporal hemianopia, fundus without edema, eye movement is not limited, no special neurological examination found. Surgical findings of bilateral visual pressure N, the middle of blue tumor removed, the pathological report of craniopharyngioma. Postoperative visual acuity recovered after January visual acuity decreased again, bilateral temporal hemianopsia. CT scan found no tumor recurrence, reoperation found that there was blue tumor before the optic chiasm, around the serious adhesion, partial cystic tumor, calcification, block removal of the tumor, loose optic N adhesion. Visual acuity was 0.9 after 14 days, visual acuity of binocular began to decline after 0.8.21 days left, visual acuity was maintained at right 0.4 and left 0.2. There was no tumor recurrence after CT examination. The reason for the rapid deterioration of visual acuity may be associated with the re-occurrence of N adhesions. Affected as N blood supply related.