sphenoid ridge meningioma eye lesions
Introduction
Introduction to ocular lesions of sphenoid ridge meningioma Meningioma is a common tumor in the brain, second only to glioma, accounting for about 1/4 of all tumors. Meningioma mainly occurs in the arachnoid endothelial cells, so it can occur anywhere in the brain except the brain parenchyma. The incidence of cerebral palsy, parasagittal sinus and cerebral convex surface is high, followed by sphenoid ridge, saddle nodule, parasagittal, bronchial groove, cerebellum and cerebellar cerebral horn, among which sphenoid bone, saddle nodule and saddle Parameningoma can invade the orbit, optic nerve and cranial nerves and cause a series of eyelid lesions. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: facial paralysis epilepsy
Cause
Etiology of ocular lesions of sphenoid ridge meningioma
The pathogenesis is still unclear. Histopathological examination of intracranial meningioma is the same as that of intraorbital meningioma. The tumor cells are round or oval, and the cell boundaries are not clear. The cells are arranged in a spiral shape and separated by fibrous tissue.
Prevention
Prevention of ocular lesions in sphenoid ridge meningioma
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Biliary sacral meningioma ocular lesion complications Complications facial paralysis
Concurrent facial paralysis, epilepsy and so on.
Symptom
Symptoms of ocular lesions of sphenoid ridge meningioma Symptoms Common symptoms Symptoms of light reflexes, dark spots, enlarged visual field, defect, orbital reduction, hemianopia, ptosis, supracondylar sacral syndrome, eyeball protrusion
The meningioma associated with the eyelids has different clinical manifestations, and the meningioma that occurs on the medial side of the sphenoid ridge is rare. It is transmitted through the supraorbital fissure or along the optic nerve sheath to the orbit, because the tumor is adjacent to the optic canal and sputum. Upper fissure, early vision loss, eye movement nerve palsy and eyeball protrusion, causing supracondylar fissure syndrome, Henderson statistics occurred in different parts of sphenoidal meningioma patients, 88% of the eyeballs appeared, 47% showed varying degrees of visual loss Tumor can cause bone hyperplasia at the tip of the iliac crest, and the tumor spreads forward, blocking the central retinal vein, causing the optic nerve ciliary vein, retinal blood is discharged through the choroidal drainage, and the other is called the optic nerve ciliary vein, visual decline and chronic optic disc edema. Atrophy is a triad of cranial-palsy meningioma.
1. 1/3 of meningioma in sphenoid ridge is attached to the anterior crest of the diseased side due to tumor. In the optic nerve, optic chiasm, supracondylar fissure and cavernous sinus, the tumor in the process of development causes oppression of the above structure, triggering a series of Clinical symptoms, early headache, visual field defect, nasal hemianopia, central dark spot enlargement, decreased vision, etc., followed by superior orbital fissure syndrome to the ophthalmology clinic, found that the patient's disease side eyelid conjunctival swelling The upper jaw is drooping, the pupil is dilated, the light reflection is slow or disappears, the eye movement is disordered, the eyeball is prominent, and some patients have Foster Kennedy syndrome, the tumor is compressed by the ipsilateral optic nerve, due to the skull Increased internal pressure caused paralysis of the optic disc, some patients had olfactory loss, and a few patients had limb hemiplegia.
2. The 1/3 of the sphenoid ridges and meningioma tumors occur in the sphenoid wing, causing hyperplasia of the lateral wall and ankle of the eyelids, narrowing of the eyelids, or direct invasion of the tumor into the sacral anterior process, causing the eyeball to protrude, 2/3 of the patients There was a diseased lateral humeral bulge with swelling of the eyelids and bulbar conjunctiva. Some patients developed central facial paralysis, hemiplegic or seizures.
3. 1/3 of meningioma in sphenoid ridges have different symptoms and signs depending on the direction of tumor growth, and may have some clinical manifestations of 1/3 or 1/3 of meningioma.
Examine
Examination of ocular lesions of sphenoid ridge meningioma
Histopathological examination: intracranial meningioma and the intraorebral meningioma have the same tissue structure, the tumor cells are round or oval, the cell boundaries are unclear, the cells are arranged in a spiral shape, separated by fibrous tissue, and the histopathology is generally divided. For type 3:
1. Endothelial or grit-shaped round or elliptical endothelial cells, which are found in the center of the vortex or near the blood vessels. This type is common (Fig. 1).
2. Fibrous tumor cells are fusiform, arranged in a fence or wavy shape, accounting for about 32% of meningiomas.
3. Circular or elliptical endothelial cells can be seen in mixed tumor tissues, and there are also fusiform tumor cells resembling fibroblasts.
4. X-ray examination in the early stage due to the small extent of the lesion, X-ray may have no significant findings, the outer wall of the eyelid may be displayed in the late stage, the sphenoid bone is large, the density of the winglet is increased, and the boundary is unclear.
5. Ultrasound exploration of lesions invaded the eyelids after ultrasound can be found in the lesions, B-ultrasound showed flattened hypoechoic lesions on the lateral side of the eyelid (with soft tissue mass) or found that the lateral fat was narrowed; A super showed lesions with irregular low reflection Ultrasound examination is helpful for the diagnosis of optic nerve sheath meningioma. However, secondary sphenoid sacral meningioma does not invade the sphenoid sacral surface or the tumor is flat. There is no positive detection. When the tumor enlarges the compression of the fat, the echo is less. An abnormal echo zone with a lot of sound attenuation.
6. CT scan of sphenoid ridge meningioma CT scan often has important findings:
1 The outer wall of the eyelid or the sphenoid bone is hypertrophic, diffuse or irregular, and the boundary is unclear.
2 There are soft tissue shadows on the temporal or intracranial side of the eye, and the tumor often has a flat or irregular shape, and the advanced tumor may be bulky (Fig. 2, 3);
3 other signs include: meningioma tail sign.
7. MRI sphenoid ridge meningioma showed low or medium signal on T1WI and T2WI, and the enhancement was obvious. Compared with CT, MRI showed better for smaller tumors, and intracranial malignant meningioma could invade the sac. In the brain, there are multiple tumors (Figure 4).
8. Cerebral angiography can understand tumor coloration and blood supply.
Diagnosis
Diagnosis and differentiation of ocular lesions of sphenoid ridge meningioma
Typical clinical symptoms can provide diagnostic clues. X-ray examination can detect sphenoid ridge and sphenoid bone, small wing hyperplasia, and sometimes sacral fissure enlargement or worm-like bone destruction, and gravel-like calcification in the lesion.
What is easily confused with sphenoid ridge meningiomas is bone dysplasia, which is a congenital bone dysplasia with a younger age. CT shows extensive bone hyperplasia such as frontal bone, sphenoid bone, humerus, and ethmoid bone. For the maxilla, etc., the main point of differentiation is to enhance the soft tissue mass in the orbit and intracranial after CT or MRI.
