Huang X M, Wang D, Lin J Y, Tang D R, Sun F Y
Tianjin Medical University Eye Hospital, College of Optometry and Ophthalmology, Tianjin Medical University Eye Institute, Tianjin 300384, China.
Zhonghua Yan Ke Za Zhi. 2018 Sep 11;54(9):665-670. doi: 10.3760/cma.j.issn.0412-4081.2018.09.006.
To investigate the clinical features, imaging features, diagnoses and therapeutic regimens of orbital ectopic meningiomas. A retrospective study. All the clinical data of 10 patients (10 eyes) with orbital ectopic meningiomas were analyzed retrospectively from August 1999 to October 2016. They included imaging data such as color Doppler ultrasound, CT and MRI, and information of diagnosis, pathology, therapeutic regimen and prognosis. The age of orbital ectopic meningiomas was 7 to 68 years old. There were 4 males and 6 females. The clinical manifestations were mainly with swollen eyelid (8 cases), exophthalmos (7 cases), visual impairment (2 cases) and accidentally found a mass in the orbit with physical examination(2 cases). The tumor was located in (5 cases) or outside (5 cases) the muscular funnel of the orbit. The imaging features of CT included the irregular shape, unclear border, and extraocular muscular adhesions (10 cases). T weighted image of MRI showed low and medium signals and T weighted image showed medium and high signals(8 cases). There was no definite diagnosis before surgery. Ten patients were treated with surgery, and it was confirmed intraoperatively that the tumors were not adjacent to the optic nerve and orbital periosteum. The pathological diagnoses were mostly epithelial meningiomas (9 cases). There were no significant changes in visual acuity, but temporary eye movement disorders occurred postoperatively (10 cases). The patients were followed for 6 months to 6 years. Two cases underwent recurrent at 3 months and 2 years after operation, and received treatment of γ-knife radiation therapy. The tumor reduced after γ-knife radiotherapy, and had no change in 2 years and 6 years, respectively. As a kind of rare orbital tumors, it is difficult to diagnose orbital ectopic meningiomas accurately. The clinical features and imaging findings can help to detect the disease, but lacking the characteristics of optic nerve sheath meningiomas and periosteal meningiomas. Surgical resection could achieve a good prognosis without visual impairment. If the tumor recurs after pathological diagnosis, γ-knife conformal radiation therapy may still be effective for tumor recurrence. .
探讨眼眶异位脑膜瘤的临床特征、影像学特征、诊断及治疗方案。一项回顾性研究。回顾性分析1999年8月至2016年10月间10例(10只眼)眼眶异位脑膜瘤患者的所有临床资料。资料包括彩色多普勒超声、CT及MRI等影像学资料,以及诊断、病理、治疗方案及预后等信息。眼眶异位脑膜瘤患者年龄7至68岁。男性4例,女性6例。临床表现主要为眼睑肿胀(8例)、眼球突出(7例)、视力障碍(2例)及体检时偶然发现眼眶肿物(2例)。肿瘤位于眼眶肌锥内(5例)或肌锥外(5例)。CT影像学特征包括形态不规则、边界不清及眼外肌粘连(10例)。MRI的T加权像呈低、中等信号,T加权像呈中等、高信号(8例)。术前均未明确诊断。10例患者均行手术治疗,术中证实肿瘤与视神经及眶骨膜不相邻。病理诊断多为上皮型脑膜瘤(9例)。术后视力无明显变化,但均出现暂时性眼球运动障碍(10例)。患者随访6个月至6年。2例分别于术后3个月及2年复发,接受γ刀放射治疗。γ刀放疗后肿瘤缩小,2年及6年时分别无变化。作为一种罕见的眼眶肿瘤,眼眶异位脑膜瘤难以准确诊断。临床特征及影像学表现有助于发现该病,但缺乏视神经鞘脑膜瘤及骨膜瘤的特征。手术切除可获得良好预后且不影响视力。病理诊断后若肿瘤复发,γ刀适形放射治疗对肿瘤复发可能仍有效。