Fu X, Wang H
Department of Neuro-ophthalmology, Xijing Hospital, 4th Military Medical University Xian, China.
Yan Ke Xue Bao. 1996 Sep;12(3):166-8.
The sella tumors were found in 15% of intracranial tumors. The sella turcica region locates in the base of skull, so the carcinoma patients in early stage often showed no intracranial hypertension and other positive signs of neural system. However, the patients presented visual field defect and hypopsia, and often went to see the doctor of ophthalmology, which resulted from that the tumor often compressed optic nerve and chiasm. We analysed the symptomatic changes of the visual organs in order to provide a diagnostic basis for sellar tumor in ophthalmological department.
Of the 407 cases of sellar tumors, 296 were pituitary adenoma, 52 were craniopharyngioma, 43 were meningioma, and the rest 16 were other kinds of sellar tumors. We analysed their ocular changes of the sellar tumors and the characteristics of the tumors.
The sellar tumor in its early stage is mainly symptomized as visual field changes. Visual field defect was found in 92.9% of pituitary adnoma, 75% of craniopharyngioma and 34.8% meningioma patients. The patients of intermediate and later sellar tumors gradually manifested the hypopsia and optic atrophy. Hypopsia was found in 86.5% of pituitary adenoma patients, 89.9% of craniopharyngioma and 48.8% of meningioma patients. The morbidity rate of optic atrophy is 59.5% in patients with pituitary adenoma, 65.5% of craniopharyngioma and 44.1% of meningioma.
The misdiagnostic rate of sellar tumor in ophthalmological department still keeps comparatively high. The reason is that: (1) The doctors lack the neuroophthalmological knowledge. (2) The patients were not examined attentively enough. The ocular symptoms of sellar tumors are often the first occurred and most important changes. In the clinical practice, all the patients showing visual acuity and visual field disturbances should be examined carefully (especially in visual field) and excluded ocular diseases, should be transferred to the department of neurosurgery for further diagnosis and treatment.
鞍区肿瘤占颅内肿瘤的15%。蝶鞍区位于颅底，因此该区域肿瘤患者早期常无颅内压增高及其他神经系统阳性体征。然而，患者常出现视野缺损及视力减退，多前往眼科就诊，这是因为肿瘤常压迫视神经及视交叉。我们分析了视觉器官的症状变化，以便为眼科诊断鞍区肿瘤提供依据。
407例鞍区肿瘤患者中，垂体腺瘤296例，颅咽管瘤52例，脑膜瘤43例，其余16例为其他类型的鞍区肿瘤。我们分析了鞍区肿瘤的眼部变化及肿瘤特征。
鞍区肿瘤早期主要表现为视野改变。垂体腺瘤患者视野缺损发生率为92.9%，颅咽管瘤为75%，脑膜瘤为34.8%。鞍区肿瘤中晚期患者逐渐出现视力减退及视神经萎缩。垂体腺瘤患者视力减退发生率为86.5%，颅咽管瘤为89.9%，脑膜瘤为48.8%。垂体腺瘤患者视神经萎缩发生率为59.5%，颅咽管瘤为65.5%，脑膜瘤为44.1%。
眼科对鞍区肿瘤的误诊率仍相对较高。原因如下：（1）医生缺乏神经眼科学知识。（2）对患者检查不够仔细。鞍区肿瘤的眼部症状往往是最早出现且最重要的变化。在临床实践中，对于所有出现视力和视野障碍的患者，应仔细检查（尤其是视野），排除眼部疾病后，应转至神经外科进一步诊治。
