Huber A
Klin Monbl Augenheilkd. 1978 Apr;172(4):627-35.
Three cases of histologically verified neurinomas of the oculomotor nerve are reported. The preoperative diagnosis in all three cases was not made; on the contrary all cases were diagnosed as sphenoid ridge meningiomas. The oculomotor neurinoma manifests itself in the beginning with a discrete progressive palsy of the oculomotor nerve leading in later stages to complete ophthalmoplegia. Proceeding the oculomotor nerve paresis or going parallel to it is a functional loss of the homolateral optic nerve sometimes progressing to amaurosis. Unilateral exophthalmos as well as frontal or orbital neuralgic pain with or without sensory disorders in the area of trigeminus-I are characteristic for the clinical picture in later stages, all symptoms characteristic for the syndrome of the apex orbitae, resp. the superior orbital fissure, resp. the anterior cavernous sinus. The differential diagnosis has to consider above all the sphenoid ridge meningioma, the trigeminal neurinoma and the numerous tumors within the cavernous sinus (aneurysmas, meningiomas, chondromas, metastases of carcinomas, pituitary adenomas etc.) or the middle cranial fossa. Plain X-ray, carotid angiogram and computer tomogram are essential diagnostic means for localization and extension of the tumor but not for histological diagnosis. Oculomotor neurinomas are very seldom. The three observed cases did not have any relation to a possible generalized neurofibromatosis.
本文报告了3例经组织学证实的动眼神经神经鞘瘤。所有3例术前均未做出诊断；相反，所有病例均被诊断为蝶骨嵴脑膜瘤。动眼神经神经鞘瘤起初表现为动眼神经的渐进性麻痹，后期导致完全性眼肌麻痹。在动眼神经麻痹之前或与之同时出现的是同侧视神经功能丧失，有时会发展为黑矇。单侧眼球突出以及伴有或不伴有三叉神经第一支区域感觉障碍的额部或眶部神经痛是后期临床表现的特征，所有这些症状都是眶尖综合征、眶上裂综合征或海绵窦前部综合征的特征。鉴别诊断首先必须考虑蝶骨嵴脑膜瘤、三叉神经鞘瘤以及海绵窦内的众多肿瘤（动脉瘤、脑膜瘤、软骨瘤、癌转移瘤、垂体腺瘤等）或中颅窝肿瘤。普通X线、颈动脉血管造影和计算机断层扫描是确定肿瘤位置和范围的重要诊断方法，但对组织学诊断无帮助。动眼神经神经鞘瘤非常罕见。观察到的这3例病例与可能的全身性神经纤维瘤病无关。
