关于视神经鞘脑膜瘤诊断和治疗的新观点

New view in the diagnosis and therapy of optic nerve sheath meningioma

视神经鞘脑膜瘤是视神经鞘最常见的肿瘤,占原发性视神经瘤的三分之一。随着先进的神经影像技术的发展,其发生率提高了。神经影像技术对该病的早期诊断具有重要的意义。大多数临床所见的病例诊断甚是可疑,许多病例并未做活组织检查,只是通过神经影像学支持诊断。视神经鞘脑膜瘤治疗的目的是确保一定的视力,控制肿瘤的局部增长,减少死亡率。对视力轻微下降或无视力障碍以及视力保持稳定的患者进行随访观察,分次立体定向放射疗法对进行性和早期的病例可以维持视力。外科切除术和活组织检查的致盲率比较高,适用于向外生长到硬脑膜的肿瘤。

Optic nerve sheath meningiomas account for one - third of primary optic nerve tumors and are the most common tumors of the optic nerve sheath. Their reported incidences have increased since the development of more advanced neuroimaging techniques, which have also significantly contributed to earlier recognition of the disease. The diagnosis can be suspected in most cases from clinical findings and supported by the results of neuroimaging, obviating tissue biopsy in the majority of cases. The main goals in the management of ONSMs are ensuring a favorable visual outcome, establishing local control of the tumor, and minimizing the risks of treatment-related morbidity. Observation may be appropriate in patients with mild or no visual deficit or in whom visual loss is not progressing, whereas stereotactic fractionated radiation therapy has been demonstrated to improve or stabilize vision in progressive or advanced cases. Attempts at surgical excision, and even biopsy, of optic nerve sheath meningiomas are associated with a high risk of blindness and should be reserved for the rare case of an anteriorly located, primarily exophytic tumor with focal involvement of the dural sheath.