累及海绵窦的颅内占位性病变神经眼科临床及病理分析  

Neurophthalmological clinical and pathological analysis of intracranial space-occupying lesion with involved cavernous sinus

作　　者：李晓明[1,2] 杨波[3] 周欢粉[2] 康皓[2] 赵朔[2] 曹珊珊[2] 魏世辉[2] 

机构地区：[1]吉林省人民医院眼科 [2]中国人民解放军总医院眼科 [3]吉林大学第二医院眼底病科

出　　处：《中国实用医药》2015年第27期6-8,共3页China Practical Medicine

摘　　要：目的分析累及海绵窦的颅内占位性病变神经眼科临床特点及病理分型。方法回顾性分析39例经眼科会诊的累及海绵窦的颅内占位性病变患者资料,总结其神经眼科临床特点和病理结果。结果 39例患者中,神经眼科临床表现:多颅神经麻痹(动眼神经、展神经、滑车神经及三叉神经分支麻痹中至少出现3种)27例,占69.23%。动眼神经或展神经麻痹12例,占30.77%。患侧眼视力下降11例,占28.21%。同侧头痛或眼眶深部痛11例,占28.21%。眼球突出3例。术中诊断及术后病理回报:海绵窦脑膜瘤15例,占38.46%;海绵窦海绵状血管瘤12例,占30.77%;海绵窦段动脉瘤6例,占15.38%;海绵窦神经鞘瘤2例,上皮样囊肿、纤维黏液瘤、软骨瘤及垂体腺瘤各1例。结论累及海绵窦的颅内占位性病变常致多颅神经麻痹,表现为复视、眼球运动障碍,部分患者可伴患侧三叉神经第Ⅰ、Ⅱ分支分布区感觉障碍、眼球突出或视力下降。眼科医生诊断时应考虑到海绵窦占位性病变的可能性。伴有神经眼科表现的海绵窦占位性病变,病理分型较为复杂,脑膜瘤、海绵状血管瘤和动脉瘤可能为相对多见的类型。Objective To analyze neurophthalmological clinical characteristics and pathological types of intracranial space-occupying lesion with involved cavernous sinus. Methods A retrospective analysis was made for clinical data of 39 patients with intracranial space-occupying lesion with involved cavernous sinus, and their neurophthalmological clinical characteristics and pathological types were summarized. Results Neurophthalmological clinical manifestations in 39 cases included 27 cases with multiple cranial nerve palsy（3 occurred types among oculomotor nerve, abducent nerve, trochlear nerve, and nervi trigeminus branch paralysis）, accounting for 69.23%, 12 cases with oculomotor nerve or abducent nerve paralysis, accounting for 30.77%, 11 cases with affected diminution of vision, accounting for 28.21%, 11 cases with ipsilateral headache or deep eye pain, accounting for 28.21%, 3 cases with protopsis. Intraoperative diagnosis and postoperative pathological returns showed 15 cases with meningiomas of cavernous sinus, accounting for 38.46%, 12 cases with cavernous sinus hemangioma, accounting for 30.77%, 6 cases with arterial aneurysm of cavernous sinus, accounting for 15.38%, 2 cases with cavernous sinus schwannoma, 1 case with epidermoid cyst, 1 case with fiber myxoma, 1 case with chondroma, and 1 case with pituitary adenoma. Conclusion Intracranial space-occupying lesion with involved cavernous sinus will mainly lead to multiple cranial nerve palsy, with the manifestations as diplopia, ocular motility disorders, and nervi trigeminus Ⅰ, Ⅱ branch sensory disorder, protopsis, or diminution of vision in some patients. Cavernous sinus space-occupying lesion is necessary for consideration. Pathological types of cavernous sinus space-occupying lesion with neurophthalmological manifestations are complex, such as meningeoma, cavernous hemangioma, and arterial aneurysm.

关 键 词：海绵窦 占位性病变 神经眼科 病理 

分 类 号：R771.3[医药卫生—眼科] R739.4[医药卫生—临床医学]