眼眶神经鞘瘤的临床诊断及手术探讨

Investigation of the diagnosis and surgery of orbital neurilemomas

目的：探讨眼眶神经鞘瘤的临床诊断和手术方法。方法回顾性分析1999年5月至2015年12月在河南科技大学第一附属医院治疗的32例（32只眼）眼眶神经鞘瘤的临床资料。结果32例中男18例，女14例。均进行A／B超检查及CT扫描检查，其中10例进行MRI成像检查。采用的手术方式：外侧开眶18例，占56．25％；前路开眶12例，占37．50％；经颅开眶2例，占6．25％。术后视力下降9例，占28．13％；视力提高8例，占25．00％；视力不变15例，占46．87％。手术并发症：早期上睑下垂7例，占21．87％；眼球运动受限9例，占28．13％；术后复发2例，占6．25％，再次行眶内容摘除术联合术后放疗。结论 CT扫描和MRI成像对眼眶神经鞘瘤的定位诊断、手术入路及病变范围提供可靠的依据。完整彻底的手术摘除可降低肿瘤的复发率和并发症的发生率。

Objective To investigate the diagnosis and surgery of orbital neurilemomas .Methods The data of 32 eyes of 32 patients with pathologically confirmed obital neurilemoma were analyzed retrospectively.Results Of 32 cases with orbital neurilememas ,18 patients were male （56.25%）,14 patients were female（43.75%）.A/B ultrasound were applied in 32 cases, and neurilemomas was found low to medium reflect or echo in the ultrasound .CT scanning illustrated soft tissue with high density mass in 26 cases, 6 cases were heterogeneity .MR imaging were examed in 10 cases and most of the neurilememas located in the muscle cone or in the superior part of the orbit .Surgical approach was lateral orbitotomy in 18 cases（56.25%）,anterior orbitotomy in 12 cases（37.50%）,transcranial orbitotomy in 2 cases（6.25%）. Visual acuity was improved in 8 eyes（25.00%）, remained unchanged（46.87%）, and decreased in 9 eyes （28.13%）.Early postoperation ptosis in 7 eyes （21.87%）, disturbance of eyeballs in 9 eyes（28.13%）, and 2 eyes（6.25%） occurred recurrence.Conclusion Modern medical imaging, especially CT scanning and MRI, can demonstrate the site, configuration, and characteristics of the tumors, and contribute to the diagnosis and surgical approach .Complete orbital neurilemomas extirpation can decrease the rate of recurrence and complication .