原发性眼眶脑膜瘤临床及影像诊断分析

Clinical and iconological diagnosis of primary orbital meningioma

目的 探讨原发性眼眶脑膜瘤的临床表现、影像学特征、诊断及治疗原则。方法 1979～ 1998年间诊治的原发性眼眶脑膜瘤 115例进行回顾性分析。详细复习了全部病例的临床 ,病理资料及 X线、B超、彩色多普勒超声、CT和(或 ) MRI的图像并进行比较。结果 原发性眼眶脑膜瘤可起源于视神经鞘和眶骨膜 ,多发生于中年女性。眼球突出、视神经萎缩、视力丧失和视睫状静脉为视神经鞘脑膜瘤的四联征。起源于眶骨膜的脑膜瘤早期出现眼球突出和移位 ,视力减退出现较晚。X线、B超、CT和 MRI有特征性表现 ,CT可以同时显示视神经增粗、眶内软组织肿块和眶骨改变 ,MRI可以更好地观察视神经管内及颅内蔓延状况。治疗原则主要为手术切除。结论 原发性眼眶脑膜瘤是一种较为常见的眼眶肿瘤 ,影像学检查有助于诊断和鉴别诊断 ,一旦确诊 。

Objective To explore the clinical manifestations, iconographic characterizations, diagnosis and treatment principles.Methods One hundred and fifteen cases of primary orbital meningiomas between 1979~1998 were analysed. All clinical and pathological materials as well as iconological results were reviewed, such as X ray, B ultrasonography, CDI, CT and(or) MRI.Results Primary orbital meningiomas could originate from the optic nerve sheath and orbital perioteum. It is common in middle aged female. Proptosis, optic nerve atrophy,visual loss and optic ciliary veins were the four main signs. Proptosis and displacement appeared more earlier in meningiomas that originate from orbital perioteum, but visual decreased late.X rays, ultrasonography, CT and MRI had their characterized signs.CT could show optic nerve enlarged, soft tissue mass in the orbit and the orbital perioteum simultaneously. MRI could observe the lesions in the optic cannel and the cranium better.The treatment principle was surgical excision of the tumor.Conclusion Primary orbital meningioma is a common orbital tumor. Iconographical examination is very helpful for diagnosis and differential diagnosis. Once the diagnosis is made, the operation should be done earlier.