首诊于眼科的128例颅脑肿瘤临床分析

Clinical analysis of 128 cases with intracranial tumor primarily diagnosed by ophthalmologic examination

目的分析首诊于眼科的颅脑肿瘤的发病率、病种分类和临床诊断特点,为其诊断与治疗提供临床依据。方法回顾性分析2002年至2007年眼科门诊初诊的经CT或MRI检查确诊、部分病理检查证实的颅脑肿瘤患者共128例的病例资料。结果128例颅脑肿瘤患者中,垂体瘤患者主诉多为视力下降、复视、头痛,可出现视神经萎缩、视野改变等;脑膜瘤患者主诉多为视力下降、眼前暗点伴头痛,5例肿瘤位于蝶骨嵴,7例位于鞍结节;鼻部肿瘤多以流泪、复视、间歇性头痛转为持续性头痛为主诉,眼部检查可见眼球突出、眼球运动受限等。每种疾病的临床体征和影像检查、视野等有各自的特点。结论首诊眼科的颅脑肿瘤以垂体瘤最常见,其次为鼻部肿瘤。结合临床体征、影像检查、视野检查作出正确诊断,以避免漏诊误诊。

Objective To investigate the incidences,classifications and clinical diagnostic characteristics of intracranial tumor primarily diagnosed by ophthalmologic examination,and to provide clinical evidence for its diagnosis and treatment.Methods Retrospective analysis was taken in clinical data of 128 cases with intracranial tumor by CT or MRI examination and pathological examination in primarily diagnosis of ophthalmologic examination from 2002 to 2007.Results In 128 cases with intracranial tumor,patients with pituitary tumor were complained of decreasing visual acuity,diplopia,headache,and may be with optic atrophy and visual field changes;Patients with meningioma were complained of decreasing visual acuity,scotoma in front of eye and headache;Tumors of 5 cases were at crista sphenoidalis,and 7 cases were at tuberculum sellae.Patients with tumor at nasal part were mainly complained of lacrimation,diplopia,intermittence headache to durative headache,and may be with exophthalmos and dyskinesia of macular apparatus by ophthalmological examination.Each disease had different characteristics of clinical features,image examination and visual field.Conclusions Pituitary tumor is the most common one,tumor at nasal part is next in intracranial tumor at primary diagnosis of ophthalmologic examination.We should make correct diagnosis with clinical features,image examination and examination of visual field to avoid missing diagnosis and misdiagnosis.