视交叉海绵状血管瘤八例  

Eight cases of cavernous hemangioma of the optic chiasm

作　　者：孟超[1] 毕智勇[2] 江汉秋[1] 景筠[1] 王佳伟[1] 

机构地区：[1]首都医科大学附属北京同仁医院神经内科,100730 [2]首都医科大学附属北京天坛医院神经外科

出　　处：《中华眼科杂志》2015年第12期907-911,共5页Chinese Journal of Ophthalmology

摘　　要：目的分析视交叉海绵状血管瘤的临床特点、影像学表现及预后。方法回顾性系列病例研究。收集2002年9月至2013年12月首都医科大学附属北京同仁医院神经内科及北京天坛医院神经外科共收治的视交叉海绵状血管瘤8例患者的临床资料，分析其临床特点、影像学表现及预后。结果8例患者中女性3例，男性5例；年龄16～58岁，年龄中位数为39．5岁。从发病至确诊，最短25d，最长2年4个月。急性病程3例，慢性进行性病程3例，慢性病程伴反复急性发作2例；所有病例均有视力下降和（或）视物遮挡等视功能改变，其中伴随头痛的3例；首发症状以单纯视力下降和（或）视物遮挡最常见，有4例；术前诊断为海绵状血管瘤的仅4例；手术全部切除血管瘤6例，非全部切除2例；术后视功能，包括视力和（或）视野改善者4例。MRI检查多表现为形态欠规则的混杂信号。结论视交叉海绵状血管瘤患者临床均有视力下降和（或）视野缺失表现，常伴发头痛，早期易误诊，头颅核磁检查有特征性改变，对明确诊断有一定帮助。尽早手术全部切除血管瘤有可能改善视功能。Objective To report the clinical characteristics, neuto-imaging and prognosis of cavernous hemangioma of the optic chiasm. Methods Retrospective data analysis was conducted in 8 patients from Beijing Tongren Hospital and Beijing Tiantan Hospital. Patients＇ clinical characteristics, neuro- imaging and prognosis were assessed. Results There were eight patients aging from 16--58 years old including 3 females and 5 males. The median age was 39.5 years. From the time of onset to diagnosis, the shortest time was 25 days and the longest was 2 years and 4 months. Clinical characteristics of 8 cases were analyzed. Among 8 cases, 3 patients had acute course, 3 patient had chronic course with acute exacerbation and 2 patients had chronic course. All patients presented with decreased visual acuity and/or visual field defect and 3 cases had headache. The most common initial manifestation was decreased visual acuity and/or visual field defect （4 cases）. Only 4 cases were diagnosed cavernous hemangioma of the optic ehiasm before surgery. The hemangioma was total resected in 6 patients and other two got partly removed. Visual function was improved in 4 cases after surgery. MRI showed mixed signal. Conclusions All patients presented decreased visual acuity and/or visual field defect, often accompanied with headache. It can be misdiagnosed at early stage. MRI may be helpful to the diagnosis. Complete resection at early stage may improve the visual function.

关 键 词：视交叉 血管瘤 海绵状 磁共振成像 

分 类 号：R739.7[医药卫生—肿瘤]