表现为眼肌麻痹的海绵窦区病变临床影像特征及病因学诊断价值  

Clinical and imaging features and etiologic diagnosis value in patients with cavernous sinus lesion presenting with ophthalmoplegia

作　　者：孙厚亮[1] 崔世磊[1] 刘磊[1] 江汉秋[1] 张晓君[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

出　　处：《中华医学杂志》2018年第3期202-207,共6页National Medical Journal of China

摘　　要：目的分析表现为眼肌麻痹的海绵窦区病变的病因谱组成，观察相应临床及影像特点及其在病因学诊断时的预测价值。方法回顾并随访2005年1月至2014年1月间，因眼肌麻痹来诊，确诊为海绵窦区病变的住院患者137例。依据临床特征、实验室检查、影像资料、病理结果等进行病因学分类，并对不同病因海绵窦病变的临床及影像资料进行统计学分析。结果炎症性疾病151例（37．2％）]是最常见的病因，早期疼痛（OR5．591，95％CI1．703～18．401）及动眼神经受累（OR4．902，95％C11．015～24．630）与炎症性疾病独立相关；肿瘤[43例（31．3％）]是本组海绵窦病变第二位病因，其中以累及海绵窦区脑膜瘤最常见，三叉神经第二支受累（OR1．017，95％CI1．005—1．071）与肿瘤独立相关。海绵窦区血管性病变28例（20．4％），其与男性性别独立相关（OR3．506，95％CI1．362～8．765）。海绵窦感染性疾病15例（10．9％），以真菌感染最常见，多继发于鼻窦感染。结论表现为眼肌麻痹的海绵窦病变病因谱主要包括炎症性、肿瘤性、血管性、感染性疾病四大类，本组资料以炎症性疾病最常见。部分海绵窦病变的临床特征对病因学有一定的预测价值，病程早期疼痛、动眼神经受累与炎症性疾病独立相关，而显著面部感觉障碍、三叉神经第二支受累更多提示肿瘤性疾病可能。优化MRI检查方法可更好地识别海绵窦区病变。Objective To classify different causes of cavernous sinus lesion in patients with ophthalmoplegia and analyze their clinical and imaging features. Methods We confirmed the etiological diagnosis of 137 hospitalized ophthalmoplegia patients with cavernous sinus lesion retrospectively from January 2005 to January 2014 in the Department of Neurology of Beijing Tongren Hospital. The diagnosis was made according to clinical feature, laboratory test, imaging studies and pathology. The clinical data of these patients were analyzed and compared among different groups. Results Fifty-one cases （37. 2% ） were confirmed as inflammatory diseases of cavernous sinus, which were the most common cause in 137 patients. Early stage pain （ OR 5. 591, 95% CI 1. 703 - 18.401 ） and involvement of oculomotor nerve （ OR 4. 902, 95% CI 1. 015 -24. 630） were independently associated with inflammatory diseases. Forty-three cases （31.3%） were confirmed to have tumor, which was the second cause of cavernous sinus lesions, and rneningioma was the most common tumor. The second branch of trigeminal nerve involvement was independently correlated （ OR 1. 017, 95% CI 1. 005 - 1. 071 ） with tumor. The percentage of male （ OR 3. 506, 95% CI 1. 362 - 8. 765 ） was significantly higher in 28 eases （ 20. 4% ） with cavernous sinus vascular lesions. Cavernous sinus infectious diseases were seen in 15 cases （ 10. 9% ） , and fungal infection was the most common, mostly secondary to sinus infection. Conclusions The common causes of cavernous sinus lesion include cavernous sinus inflammatory diseases, neoplastic diseases, vascular diseases and infectious diseases, and inflammatory diseases is the most commonly seen cause in this group of patients. Obvious facial sensory disturbances and the second branch of trigeminal nerve involvement are independent associated with tumor. The early course of pain and involvement of oculomotor nerve areassociated with inflammatory diseases. Optimization of MRI examination method can better ident

关 键 词：海绵窦综合征 TOLOSA-HUNT综合征 痛性眼肌麻痹 病因学 

分 类 号：R777.45[医药卫生—眼科]