侧脑室三角区脑膜瘤的眼部表现及视放射损害的相关因素分析  

Ocular manifestations of intraventricular trigonal meningioma and the associated optic radiation injury

作　　者：王淑然[1] 瞿远珍[1] 杨柳[1] 方民[1] 

机构地区：[1]首都医科大学附属北京天坛医院眼科,中国北京市100050

出　　处：《国际眼科杂志》2016年第8期1511-1514,共4页International Eye Science

摘　　要：目的：分析侧脑室三角区脑膜瘤患者的眼部表现特点,探讨导致视功能损害的可能相关因素,以及在临床诊治中的注意事项。方法：回顾分析2011-10/2015-10在首都医科大学附属北京天坛医院诊治的45例90眼侧脑室三角区脑膜瘤患者病例资料,对患者术前视力、视野、视乳头改变、肿瘤大小、肿瘤周围组织变化等进行分析。结果：患者年龄12~68（平均41.7±13.7）岁,男女比例1∶4.6;视力下降18眼,视乳头水肿24眼,视乳头色淡6眼,视野缺损47眼,其中视野缺损类型以双眼对侧同向性缺损为主;肿瘤最大径2.1~9.6（平均4.8±1.7）cm;肿瘤体积3.02~193.2（平均48.3±47.8）cm3。Spearman分析显示肿瘤体积、肿瘤最大径和脑中线结构移位与术前出现视野缺损呈正相关。而患者年龄、性别、病程、脑室是否扩大、肿瘤周围组织是否水肿与术前出现视野缺损无明显相关性。经Mann-Whitney U检验,术前视野受损组和视野正常组之间肿瘤体积、肿瘤最大径、脑中线移位值均有显著性差异。结论：较多三角区脑膜瘤患者存在眼部症状和体征,患者视功能损害的原因主要是由于肿瘤对周围视放射的破坏导致。肿瘤大小、生长方向、对周围视放射压迫的具体位置决定了患者是否出现视野缺损以及视野缺损的类型和程度。对于靠近视放射等后视路的颅脑占位,眼科医生和神经外科医生要重视其神经眼科学检查,注意肿瘤与周围视路等功能区的位置关系,这对于手术时机选择、手术方案制定及改善预后具有重要意义。AIM： To analyze the ocular manifestations of m eningiom as in the trigone of the lateral ventricle,discuss the relevant factors of visual im pairm ent in these patients and things need attention clinically.METHODS： Retrospectively study on the clinical data of90 eyes in 45 patients diagnosed of trigonal m eningiom as treated at Beijing Tian Tan Hospital from October 2011 to October 2015. Preoperative exam inations including visual acuity,optic disc findings,visual field,size of tum ors and other change in MRI were analyzed.RESULTS： Patients＇ age was 12-68 years old（ mean41. 7 ± 13. 7 years）. Male / fem ale ratio was 1 ∶ 4. 6.Decreased visual acuity occurred in 18 eyes. Optic disc edem a was found in 24 eyes and optic disc pale in 6 eyes.Fourty-seven eyes had visual field defect, m ostly hom onym ous hem ianopia or defect. The m axim um diam eter of tum ors was 2. 1-9. 6cm（ 4. 8±1. 7cm）. Range of tum or volum e was 3. 02-193. 2cm3（ 48. 3±47. 8cm3）. A positive correlation of preoperative visual field defect was found with tum or volum e, tum or m axim um diam eter,and brain m idline shift respectively. While the preoperative visual field defect was not found any correlation with age, gender, course, and the enlargem ent of the ventricle and the edem a of the tissue around the tum ors. After Mann-Whitney U test, thedifferences on tum or volum e,the m axim um diam eter of tum ors,and brain m idline shift between the two groups were significant.CONCLUSION： Patients with trigonal meningiomas often have ocular signs and sym ptom s. The m ajor reason of visual field defect is the dam age of optic radiation around the tum or. The specific position of injured optic radiation determ ines the type and extent of visual field defect. Both ophthalm ologist and neurosurgeon should pay attention to tum ors nearby posterior visual pathway.Doing neurophthalm ology exam inations for these patients and realizing the position between the tum or and posterior visual pathway will be helpful and necessary in su

关 键 词：侧脑室脑膜瘤 侧脑室三角区 视放射 

分 类 号：R739.45[医药卫生—肿瘤]