眼眶异位脑膜瘤临床分析

Clinical analysis of orbital ectopic meningiomas

目的探讨眼眶异位脑膜瘤的临床特征、影像学特点、诊断及治疗。方法回顾性系列病例研究。选取1999年8月至2016年10月天津医科大学眼科医院、天津医科大学附属第二医院、天津市眼科医院诊治的10例（10只眼）眼眶异位脑膜瘤患者的全部临床资料及随访资料，包括彩色超声、cT及MRI等影像学资料，病理学资料，诊断、治疗及预后情况等进行总结分析。结果10例眼眶异位脑膜瘤患者均为单眼发病，其中男性4例，女性6例，就诊年龄7-68岁。患者主诉主要为眼睑肿胀（8例）、眼球突出（7例）、视力下降（2例）及查体偶然发现（2例）。肿瘤位置位于肌锥内5例、肌锥外5例，10例患者CT特征表现为形状不规则占位，边界不清，与眼外肌关系密切，视神经无增粗，眶骨壁无增厚；8例患者MRI表现为T。加权像中低信号，T2加权像中高信号。10例患者均行手术治疗，术前均未做出明确诊断，术中确认肿瘤与视神经、蝶骨嵴及骨膜无联系，病理学诊断大多为上皮型脑膜瘤（9例）。术后视力无明显变化，10例患者术后均有暂时性眼球运动障碍。随访6个月至6年，8例患者无肿瘤复发，2例分别在术后3个月和2年肿瘤复发，行γ刀放射治疗后肿瘤缩小，分别随访2年和6年肿瘤无变化。结论眼眶异位脑膜瘤是一种罕见的眼眶肿瘤，术前准确诊断较困难，临床特征及影像学检查可发现病变，但缺乏视神经、蝶骨嵴及骨膜来源脑膜瘤的特征。手术切除对视力影响小，预后较好。病理学确诊后，γ刀适形放射治疗对于复发肿瘤仍然有效。（中华眼科杂志，2018，54：665-670）

Objective To investigate the clinical features, imaging features, diagnoses and therapeutic regimens of orbital eetopic meningiomas. Methods A retrospective study. All the clinical data of 10 patients （10 eyes） with orbital ectopic meningiomas were analyzed retrospectively from August 1999 to October 2016. They included imaging data such as color Doppler ultrasound, CT and MRI, and information of diagnosis, pathology, therapeutic regimen and prognosis. Results The age of orbital eetopic meningiomas was 7 to 68 years old. There were 4 males and 6 females. The clinical manifestations were mainly with swollen eyelid （8 cases）,exophthalmos （7 cases）, visual impairment （2 cases） and accidentally found a mass in the orbit with physical examination（2 cases）. The tumor was located in （5 cases） or outside （5 cases） the muscular funnel of the orbit. The imaging features of CT included the irregular shape, unclear border, and extraocular muscular adhesions （10 cases）. TI weighted image of MRI showed low and medium signals and T2 weighted image showed medium and high signals（8 cases）. There was no definite diagnosis before surgery. Ten patients were treated with surgery, and it was confirmed intraoperatively that the tumors were not adjacent to the optic nerve and orbital periosteum. The pathological diagnoses were mostly epithelial meningiomas （9 eases）. There were no significant changes in visual acuity, but temporary eye movement disorders occurred postoperatively （10 cases）. The patients were followed for 6 months to 6 years. Two cases underwent recurrent at 3 months and 2 years after operation, and reeeived treatment ofγ-knife radiation therapy. The tumor reduced after γ-knife radiotherapy, and had no change in 2 years and 6 years, respectively. Conclusions As a kind of rare orbital tumors, it is difficult to diagnose orbital ectopicmeningiomas accurately. The clinical features and imaging findings can help to detect the disease, but lacking the characteristics of optic nerve sheath meningiomas and periosteal meningiomas. Surgical resection could achieve a good prognosis without visual impairment. If the tumor recurs after pathological diagnosis, ＂y-knife conformal radiation therapy may still be effective for tumor recurrence. （Chin J Ophthalmol, 2018, 54： 665-670）