蝶骨嵴脑膜瘤的眼科临床特点探讨

Ophthalmological clinical findings of sphenoid ridge meningioma

目的探讨分析蝶骨嵴脑膜瘤眼科临床特点及影像学特征。方法回顾分析北京武警总医院眼眶病研究所2000年10月～2007年10月收治的蝶骨嵴脑膜瘤49例病历资料。部分经过B型超声、X线检查,全部进行CT、MRI检查。47例手术治疗,病理证实;2例γ刀治疗。随访3个月至5年。结果患者的主要临床表现为眼球突出49例(100%),眼球运动障碍32例(65.3%),眼睑和结膜淤血水肿21例(42.8%)。视盘水肿或色淡13例(26.5%),眼底检查发现视网膜睫状静脉4例(8.1%)。首诊于眼科29例,神经科20例,较易误诊为眶内炎性假瘤和骨纤维异常增生症。CT扫描示蝶骨嵴骨增生,于眶外上方肌锥外,可见不规则软组织密度肿物影。MRIT1、T2蝶骨嵴骨肥厚影像,瘤体组织显示中信号,增强明显。结论蝶骨嵴脑膜瘤在眼科较易误诊,行加强MRI检查是临床诊断的可靠手段。眼球突出,视力下降,眼球运动障碍是其突出表现,结膜淤血红肿则是其特征性表现。

Objective To investigate the clinical and radiographic features of sphenoid ridge meningioma. Methods A retrospective review of all the cases of sphenoid ridge meningioma at Armed Police General Hospital of Beijing from October 1 , 2000 to October 1,2007 identified 49 patients by X-ray, computed tomography （CT）, magnetic resonance imaging（MRI） and ultrasound examination. Forty-seven cases were diagnosed and verified by operation and pathology. Two patients were treated by 31 knife. The follow-up period was 5 years. ResuIts The proptosis was found in all of cases（ 100% ）. Thirty-two cases（65.3% ） appeared restriction of eye movement, and 21 cases（42.8% ）showed edema and congestion in eyelid and conjunctiva. Papilledema was seen in 13 cases （26.5%）, and optico-ciliary vein was seen in 4 cases （8. 1% ）. Twenty-nine patients firstly visited ophthalmologist, and 20 patients visited neurologist firstly. Sphenoid ridge meningioma was frequently misdiagnosed as fibrous dysplasia and inflammatory pseudotumor. Marked hyperostotic changes in sphenoid ridge and the abnormal signal intensity area by the orbital cavity were shown in CT. Tl-weighted and T2-weighted axial MRI scan showed hyperostotic changes of spheroid bone. Dolinium-enhanced T1-weighted axial MRI fat-suppressed scan showed extension of sphenoorbital meningioma. Conclusion Sphenoid ridge meningioma are easily misdiagnosed in department of ophthalmology. Enhance MRI imaging could contribute vellability device to diagnosis. Proptosis, loss of visual acuity and oculomotor nerve palsy are important clinical features of meningioma. Conjunctival edema is significant clinical features.