眶尖部及视神经肿瘤的早期诊断

Early diagnosis of the tumors in orbital apex and optic nerve

目的 探讨眶尖部及视神经肿瘤在眼球突出前的临床表现、影像学检查特征及临床诊断要点。方法 回顾性分析 2 2例无明显眼球突出单侧眼眶肿瘤患者的病历资料 ,包括主要症状、首发表现、临床诊治过程及影像学检查结果。结果 2 2例肿瘤患者中 ,海绵状血管瘤 6例 ,神经鞘瘤、视神经鞘脑膜瘤、鼻窦及鼻咽腔恶性肿瘤眶内蔓延各 4例 ,后组筛窦黏液囊肿 2例 ,神经纤维瘤和视神经胶质瘤各 1例。以视力下降为首发症状者 17例 ,视力下降合并复视者 3例。全部患者均在CT或MRI检查后确诊。肿瘤位于眶尖部或起源于视神经。结论 眶尖部及视神经肿瘤的早期症状是视功能障碍 ,无眼球突出表现。视力呈缓慢进行性下降 ,按视神经炎治疗效果差。CT或MRI检查对早期诊断起重要作用。 (中华眼科杂志 ,2 0 0 4,40 :3 4 3 6)

Objective To obtain clues for early diagnosis of the tumors in orbital apex and optic nerve. Methods Twenty-two cases (22eyes) of orbital tumors without proptosis were collected, and their clinical manifestations, especially main or first symptoms, the course of their diagnosis and treatment as well as the data of ultrasonography-B, CT and MRI were analyzed. Results Among 22 cases of the orbital tumors, there were 6 cases of cavernous hemangioma, 6 cases of the tumors from paransal sinuses or nasopharyngeal cavity, 4 cases of neurilemmoma and optic nerve sheath meningioma, neurofibroma, and 1 case of optic nerve glioma. There were 17 cases with visual impairment as the first presenting symptom and 3 cases with visual impairment associated with diplopia which was misdiagnosed as optic neuritis or optic atrophy. Finally, all cases were diagnosed accurately by CT or MRI. The vast majority of that originated from the orbital apex or optic nerve sheath, and the biggest diameter of the tumors was smaller than 1.5 cm. Conclusions The early symptoms of the tumors in orbital apex and optic nerve tumors were visual impairment without proptosis. It is important that these patients were examined early by CT and MRI. (Chin J Ophthalmol,2004,40:34-36)