Sarkies N J
Department of Neuro-Ophthalmology, National Hospital for Nervous Diseases, Queen Square, London.
Eye (Lond). 1987;1 ( Pt 5):597-602. doi: 10.1038/eye.1987.92.
Twenty-two cases of optic nerve sheath meningioma were reviewed. The clinical features included slowly progressive visual loss in every case. Orbital signs of limited ocular movements and mild proptosis were present in only a third of cases; gaze-evoked amaurosis occurred in 3 cases. The disc was abnormal in every case, usually swollen if vision was 6/12 or better, atrophic if the vision worse than 6/12. Optociliary shunt vessels occurred in 5 patients and were of diagnostic significance. The diagnosis was made by a high-resolution CT scan of the orbits showing tubular expansion of the optic nerve sheath. Calcification of the optic nerve was present in 12 cases. Tubular expansion of the optic nerve sheath may occur in raised intracranial pressure, optic nerve glioma, granuloma, lymphoma or metastatic disease. In the absence of calcification these alternative diagnoses must be considered. Surgery, undertaken for the intracranial component of the tumour, did not halt progressive visual loss.
回顾了22例视神经鞘脑膜瘤病例。临床特征包括每例均有缓慢进展的视力丧失。仅三分之一的病例出现眼球运动受限和轻度眼球突出的眼眶体征；3例出现注视诱发黑矇。每例视盘均异常，若视力为6/12或更好通常肿胀，若视力低于6/12则萎缩。5例患者出现视睫分流血管，具有诊断意义。通过眼眶高分辨率CT扫描显示视神经鞘呈管状扩张做出诊断。12例存在视神经钙化。视神经鞘的管状扩张也可能发生于颅内压升高、视神经胶质瘤、肉芽肿、淋巴瘤或转移性疾病。在无钙化的情况下，必须考虑这些其他诊断。针对肿瘤颅内部分进行的手术并未阻止视力的渐进性丧失。
