颅眶交界性肿瘤的临床特征及治疗

The clinical analysis of cranio-orbital communicating tumors

目的探讨颅眶交界性肿瘤的临床诊断、治疗方法及效果。方法回顾性系列病例研究。分析天津市第一中心医院眼科2009年9月至2012年2月间所诊治的颅眶交界性肿瘤患者22例的临床资料。全部病例行CT和MRI检查，均显示颅眶交界性病变，其中实施手术16例，放射治疗6例。结果22例中骨样骨瘤2例，脑膜瘤3例，动脉瘤样骨囊肿1例，黏液囊肿2例，神经鞘瘤2例，泪腺腺样囊性癌2例，转移癌2例，横纹肌肉瘤2例，其他6例患者行放射治疗无病理诊断。8例患者行开眶手术切除肿瘤，包括眶内容物切除（1／8），前路开眶（3／8）以及外侧开眶（4／8）；8例经颅切除肿瘤，包括额颞眶顶入路（3／8）和翼点入路经颅肿瘤切除（5／8）。术后视力提高3例，无变化10例，下降3例，术后因肿瘤转移死亡2例；经颅手术入路患者中，术后出现眼球运动障碍者1例，上睑下垂1例，球结膜水肿1例，经开眶人路手术者，发生上述并发症分别为7例、5例、6例；放疗患者经影像学复查，肿瘤体积缩小4例，无变化2例。结论颅眶交界性肿瘤临床诊断主要依靠CT和MRI，结合MRI强化显像技术有利于肿瘤的鉴别诊断。经颅切除颅一眶交界性肿瘤是一种有效的手术入路。

Objective To investigate the clinical manifestations, imageological features, surgical approaches and prognosis of cranio-orbital communicating tumors. Methods The retrospective analysis was performed in the 22 patients of cranio-orbital communicating tumors in the past three years. CT and MRI examnations were applied in all cases. Of 16 patients were treated by surgical approaches, Of 6 patients were for radiation therapy. Results Of 22 cases, 2 cases were osteoid osteoma, 3 cases were meningioma, 1 case was aneurysmal bone cyst, 2 cases were mucous cyst, 2 cases were schwannoma, 2 cases were adenoid cystic carcinoma of lacrimal gland, 2 cases were metastatic carcinoma, and 2 cases were rhabdomyosarcoma. Other 6 cases were treated by radiotherapy without pathological diagnosis. 8 cases for orbital operation including excision of orbital contents 1/8, anterior orbitotomy 3/8, and lateral orbitotomy 4/8, and 8 cases for transcranial operation including frontotemporal orbital roof approach 3/8 and pterion approach 5/8. After operation, the vision acuity of 3 cases was improved, of 10 cases was unchanged and of 3 cases was decreased. Two patients died of metastasis. Among 8 cases of transcranial operation, the complaints such as eye movement disorder, proptosis and conjunctival edema emerged in 1 case. However, among 8 cases of orbital operation, such above complaints were respectively found in 7, 5 and 6 cases. Conclusions CT and MR/ have the great value for diagnosis of cranio-orbital communicating tumors, especially combined with enhanced contrast MRI. Resection of cranio-orbital communicating tumors via the transcranial surgical approach is the effective surgical approach for cranio-orbital communicating tumors.