颅底脊索瘤和软骨肉瘤是罕见的局部侵袭性间质肿瘤的不同类型，它们具有共同的影像学检查和多学科护理的关键原则。最大程度安全的手术切除是每种疾病的治疗选择，通常通过扩大内窥镜鼻内入路，伴或不伴多层颅底修复。术后辅助放射治疗经常进行，通常采用粒子治疗，例如质子束治疗 (PBT)。与光子疗法相比，PBT 能够实现剂量递增，同时限制对剂量限制性神经结构（特别是脑干和视神经结构）的损害，因为能量沉积以最高的最大值传递，并在穿透范围末端快速下降（布拉格峰）现象）。总体或最大安全切除后 PBT 的基本要求是组织诊断、切除后残留肿瘤最小化以及从 PBT 剂量限制结构中充分清除。放射科医生应了解手术方法和手术技术，包括多层颅底修复，并了解术后影像学表现随时间的演变。对所有相关术前影像学检查以及术中和术后 MRI 检查进行准确的放射学检查在管理中发挥着关键作用。放射学报告应反映颅底外科医生和放射肿瘤科医生需要了解的信息，包括肿瘤与 PBT 剂量限制结构之间的距离、通过内窥镜鼻内途径可能难以到达的肿瘤部位、硬膜内肿瘤与神经血管之间的关系结构和肿瘤部位对切除后稳定性的影响。 ©RSNA，2024 本文提供了补充材料。

Skull base chordomas and chondrosarcomas are distinct types of rare, locally aggressive mesenchymal tumors that share key principles of imaging investigation and multidisciplinary care. Maximal safe surgical resection is the treatment choice for each, often via an expanded endoscopic endonasal approach, with or without multilayer skull base repair. Postoperative adjuvant radiation therapy is frequently administered, usually with particle therapy such as proton beam therapy (PBT). Compared with photon therapy, PBT enables dose escalation while limiting damage to dose-limiting neurologic structures, particularly the brainstem and optic apparatus, due to energy deposition being delivered at a high maximum with a rapid decrease at the end of the penetration range (Bragg peak phenomenon). Essential requirements for PBT following gross total or maximal safe resection are tissue diagnosis, minimal residual tumor after resection, and adequate clearance from PBT dose-limiting structures. The radiologist should understand surgical approaches and surgical techniques, including multilayer skull base repair, and be aware of evolution of postsurgical imaging appearances over time. Accurate radiologic review of all relevant preoperative imaging examinations and of intraoperative and postoperative MRI examinations plays a key role in management. The radiology report should reflect what the skull base surgeon and radiation oncologist need to know, including distance between the tumor and PBT dose-limiting structures, tumor sites that may be difficult to access via the endoscopic endonasal route, the relationship between intradural tumor and neurovascular structures, and tumor sites with implications for postresection stability. ©RSNA, 2024 Supplemental material is available for this article.