Orbital lesions of sphenoid meningiomas
Introduction
Introduction to orbital lesions of sphenoidal meningioma The sphenoid bone area is one of the most common sites of tumors. Due to the anatomical relationship, it is also the most common intracranial tumor that invades the eyelids. basic knowledge The proportion of illness: 0.0002%-0.0003% Susceptible people: no special people Mode of infection: non-infectious Complications: ocular dyskinesia vascular injury cerebral infarction
Cause
Causes of orbital lesions in sphenoidal meningioma
(1) Causes of the disease
do not know yet.
(two) pathogenesis
Most of the tumors are endothelial and fibrous. There are two kinds of tumor growth methods. One is expansive growth, which is nodular, with narrow pedicles, larger, and relatively easy to operate. Another kind of growth, It is carpet-like and has extensive adhesion to the dura mater of the skull base. It is difficult to completely cut the operation and forms different clinical manifestations according to its growth characteristics.
Prevention
Prevention of orbital lesions in sphenoidal meningioma
Prevention: Pay attention to food hygiene and avoid carcinogens such as benzopyrene and nitrosamines from entering the body. Pay attention to personal hygiene, exercise, enhance resistance and prevent viral infection.
Complication
Complications of orbital lesions in sphenoidal meningioma Complications, eye movement disorder, vascular injury, cerebral infarction
Facial paralysis, epilepsy, etc., may have some complications after craniotomy:
1. Physical motor dysfunction, excessive traction or vasospasm affects the motor center.
2. Sports aphasia, caused by excessive traction in the lower part of the frontal lobe.
3. Cranial nerve function damage, hemorrhage hemianopia, blindness, eye movement disorder, the first dysfunction of the trigeminal nerve.
4. Cerebral infarction, internal carotid artery, middle cerebral artery, anterior cerebral artery or lateral fissure vascular injury, caused by sputum.
5. Subthalamic lesions, caused by direct injury or ischemia during surgery.
Once the above complications occur, treatments such as microcirculation drugs, neuro-metabolic drugs, energy mixture agents, dehydration drugs, hyperbaric oxygen chambers and symptomatic treatment should be actively provided.
Symptom
Symptoms of orbital lesions of sphenoid sacral meningioma Common symptoms supracondylar fissure syndrome humeral calcification locating signs scoliosis deformation sinusoidal intracranial pressure increased light reflex
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: early symptoms of medial type are obvious. Because the tumor is attached to the anterior cleft of the diseased side, in the optic nerve, optic chiasm, supracondylar fissure and cavernous sinus, the tumor is in the process of development. The structure causes oppression, triggering a series of clinical symptoms. The patient may have cranial nerve compression in the early stage. The patient has headache, visual field defect, nasal hemianopia, central dark spot enlargement, decreased vision, etc., such as tumor invasion into the orbit or sacral fissure. The ocular venous return was blocked, followed by superior orbital fissure syndrome to the ophthalmology clinic. It was found that the patient's diseased eyelid conjunctiva was swollen, the ptosis was drooping, the pupil was dilated, the light reflection was slow or disappeared, and the eye movement was observed. Obstruction, prominent eyeballs, and some patients with Foster Kennedy syndrome, tumor compression caused by atrophy of the ipsilateral optic nerve, due to increased intracranial pressure caused by contralateral optic disc edema, medial patients can also appear II, IV, VI and V the first symptom of cranial nerve damage, some patients with psychiatric symptoms and olfactory disorders are more common in tumors growing in the front cranial fossa, but less common A small number of patients have limb hemiplegia.
2. 1/3 of the sphenoid ridge and meningioma: the symptoms of lateral sphenoid ridge meningioma appear later, the tumor occurs in the sphenoid wing, causing hyperplasia of the lateral wall and ankle of the eyelid, narrowing of the eyelid, or direct tumor Invading the iliac crest causes the eyeball to protrude. Two-thirds of the patients have a diseased lateral humeral bulge with swelling of the eyelid and conjunctiva. In the early stage, there is only a headache and lack of localization signs. Some patients may present with temporal lobe seizures, such as tumor invasion of the tibia. There is an uplift of the ankle bone.
3. 1/3 of meningioma in sphenoid ridge: 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.
When the above patients have large tumor growth, they will cause muscle weakness and increased intracranial pressure in the contralateral limbs. Some patients have central facial paralysis, hemiparesis or seizures.
Examine
Examination of orbital lesions of sphenoidal 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 three types:
1. Endothelial or grit type: Round or elliptical endothelial cells, which are common in the center of the vortex or in the vicinity of the blood vessels.
2. Fibrous type: The tumor cells are fusiform, arranged in a fence or wavy shape, accounting for about 32% of meningiomas.
3. Mixed type: Circular or elliptical endothelial cells can be seen in the tumor tissue, 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, the X-ray may have no significant findings. In the advanced stage, the outer wall of the eyelid may be displayed, the sphenoid bone is large, the density of the winglet is increased, and the boundary is unclear.
5. Ultrasound exploration: Ultrasound can only detect lesions after the lesion invades the eyelids. B-ultrasound shows flattened hypoechoic space-occupying lesions on the lateral side of the eyelid (with soft tissue mass) or narrowing of the lateral fat of the tendon; A-supervised lesions are irregularly low. Reflex and ultrasonography are helpful for the diagnosis of optic nerve sheath meningiomas, but secondary sphenoid meningioma does not invade the sphenoid sacral surface or the tumor is flat. No positive findings can be seen. When the tumor is enlarged and compressed, the echo can be seen. An abnormal echo zone with less sound attenuation.
6. CT scan: visible spherical growth of the tumor centered on the sphenoid ridge, the boundary is clear, the tumor shadow is enhanced after contrast enhancement, such as tumor compression lateral vein, cerebral edema is more significant, CT scan of sphenoid ridge meningioma Often 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;
3 other signs include: meningioma tail sign.
7. MRI: MRI is meaningful for the diagnosis of this disease. MRI can show the relationship between tumor and sphenoid wing and eyelid, bone destruction, etc., especially for medial sphenoid ridge meningioma, MRI can also provide tumor In relation to the internal carotid artery, sometimes the tumor encloses the internal carotid artery, or the tumor attaches to the cavernous sinus. These conditions have important reference value for surgical removal of the tumor, and the enhanced MRI image is clearer.
The sphenoid ridge meningiomas showed low or medium signal on T1WI and T2WI, and the enhancement was obvious. Compared with CT, MRI showed better results for smaller tumors. Intracranial malignant meningioma can invade the sacral and intracranial. Multiple tumors.
8. Cerebral angiography: It can understand the coloration of the tumor and its blood supply. Now it is no longer necessary to do the localization diagnosis, but it can provide the blood supply artery of the tumor, the adjacent relationship between the tumor and the main blood vessels, and the main artery of the medial sphenoid ridge meningioma. From the branch of the ophthalmic artery, such as the development of the tumor in the anterior cranial fossa, the blood supply to the anterior ethmoid artery can be seen. At the same time, the siphon of the internal carotid artery can be opened. Sometimes the internal carotid artery is directly invaded by the tumor, which is characterized by irregular wall and lateral sphenoid ridge. The blood supply of the tumor mainly comes from the branch of the external carotid artery, such as the middle meningeal artery. The typical radial tumor blood vessels appear. The tumor staining is more obvious in the venous phase than in the arterial phase. Due to the tumor compression, the lateral middle image shows that the middle cerebral artery is generally raised. At the same time as cerebral angiography, when the external carotid artery is seen, blood vessel embolization can be performed at the same time, which reduces the surgical bleeding.
Diagnosis
Diagnosis and diagnosis of orbital lesions in sphenoid sac tumor
According to the clinical manifestations, combined with CT and MRI, clinical diagnosis can be made clearly. 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, sand-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.
