Cockerham K P, Cockerham G C, Stutzman R, Hidayat A A, Depper M H, Turbin R E, Kennerdell J S
Ophthalmology Department, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Surv Ophthalmol. 1999 Nov-Dec;44(3):226-34. doi: 10.1016/s0039-6257(99)00100-9.
Schwannomas (neurilemomas) are benign tumors that arise from Schwann cells in the peripheral nervous system. The most commonly involved nerves that cause neuro-ophthalmic manifestations are cranial nerves V and VIII. In this series of three women, schwannomas presented as intraconal masses that mimicked a cavernous hemangioma, a superior orbital mass transgressing the superior orbital fissure, and an expansive frontal lobe mass with clinical symptoms and signs of increased intracranial pressure. Although all three complained of visual blurring, none of our patients presented with Vth or VIIIth cranial nerve dysfunction. Histopathologic studies demonstrated well-circumscribed, encapsulated spindle-cell lesions with classic Antoni A and B patterns. Histopathologic examination is essential to confirm the diagnosis of a schwannoma that may be otherwise clinically confusing. Direct optic nerve compression, globe indentation with induced hyperopia, or increased intracranial pressure with optic nerve compromise may be responsible for visual symptoms. A multidisciplinary approach is often required because of the size and location of schwannomas.
施万细胞瘤（神经鞘瘤）是起源于周围神经系统施万细胞的良性肿瘤。引起神经眼科表现的最常受累神经是第Ⅴ和第Ⅷ颅神经。在这组三名女性患者中，施万细胞瘤表现为模仿海绵状血管瘤的肌锥内肿块、越过眶上裂的眶上肿块以及具有颅内压升高临床症状和体征的额叶扩展性肿块。尽管三人都主诉视力模糊，但我们的患者均未出现第Ⅴ或第Ⅷ颅神经功能障碍。组织病理学研究显示界限清楚、有包膜的梭形细胞病变，具有典型的Antoni A和B型。组织病理学检查对于确诊可能在临床上造成混淆的施万细胞瘤至关重要。直接的视神经受压、眼球凹陷伴诱导性远视或颅内压升高伴视神经损害可能是视觉症状的原因。由于施万细胞瘤的大小和位置，通常需要多学科方法。
