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目的分析累及海绵窦的颅内占位性病变神经眼科临床特点及病理分型。方法回顾性分析39例经眼科会诊的累及海绵窦的颅内占位性病变患者资料,总结其神经眼科临床特点和病理结果。结果 39例患者中,神经眼科临床表现:多颅神经麻痹(动眼神经、展神经、滑车神经及三叉神经分支麻痹中至少出现3种)27例,占69.23%。动眼神经或展神经麻痹12例,占30.77%。患侧眼视力下降11例,占28.21%。同侧头痛或眼眶深部痛11例,占28.21%。眼球突出3例。术中诊断及术后病理回报:海绵窦脑膜瘤15例,占38.46%;海绵窦海绵状血管瘤12例,占30.77%;海绵窦段动脉瘤6例,占15.38%;海绵窦神经鞘瘤2例,上皮样囊肿、纤维黏液瘤、软骨瘤及垂体腺瘤各1例。结论累及海绵窦的颅内占位性病变常致多颅神经麻痹,表现为复视、眼球运动障碍,部分患者可伴患侧三叉神经第Ⅰ、Ⅱ分支分布区感觉障碍、眼球突出或视力下降。眼科医生诊断时应考虑到海绵窦占位性病变的可能性。伴有神经眼科表现的海绵窦占位性病变,病理分型较为复杂,脑膜瘤、海绵状血管瘤和动脉瘤可能为相对多见的类型。
Objective To analyze the clinical features and pathological classification of intracranial space-occupying lesions involving the cavernous sinus. Methods Retrospective analysis of 39 cases of intracranial space occupying lesions involving the cavernous sinus treated by ophthalmology, and summarized their clinical features and pathological findings. Results The clinical manifestations of neuro - ophthalmology in 39 patients were: multiple cranial nerve palsy (at least 3 appeared in oculomotor nerve, spinal nerve, trochlear nerve and trigeminal nerve branch paralysis), accounting for 69.23%. Oculomotor nerve or parapharyngeal nerve paralysis in 12 cases, accounting for 30.77%. Myopic eye decreased in 11 cases, accounting for 28.21%. Ipsilateral headache or deep orbital pain in 11 cases, accounting for 28.21%. 3 cases of prominent eyeballs. Intraoperative diagnosis and postoperative pathological findings: cavernous sinus meningioma in 15 cases, accounting for 38.46%; cavernous sinus cavernous hemangioma in 12 cases, accounting for 30.77%; cavernous sinus aneurysm in 6 cases, accounting for 15.38%; cavernous sinus schwannoma 2 cases, epithelioid cyst, fibrous myxoma, chondroma and pituitary adenoma in 1 case. Conclusion Intracranial space-occupying lesions involving the cavernous sinus often cause paralysis of the cranial nerves, showing diplopia and ocular motility disorders. Some patients may have sensory disturbances in the branches Ⅰ and Ⅱ of the trigeminal nerve in the affected side, with prominent or decreased visual acuity . Ophthalmologists should consider the possibility of occupying cavernous sinus lesions. Cavernous sinus space-occupying lesions accompanied by neuro-ophthalmologic manifestations are more complex pathological types. Meningiomas, cavernous hemangiomas and aneurysms may be relatively common types.