鼻-眼眶-颅底恶性肿瘤继发眶尖综合征1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2023.458

摘要/Abstract

摘要： 目的探讨以眶尖综合征为首发症状的鼻源性疾病的病因及其早期诊断要点。方法报道1例74岁女性患者的病历资料。其因“双眼上睑松弛伴遮挡感,左眼为甚4个月余”就诊,入院行左眼上睑下垂矫正术,术后左眼上睑下垂矫正良好。术后2周,其左眼视力下降伴眼痛、头痛就诊,再次入院进一步完善检查。结果左眼球向正前方固定、各方向运动障碍,视盘充血水肿,后极部及视盘周围可见线状出血及散在棉绒斑。完善眼眶、颅脑MRI及副鼻窦CT检查,发现鼻部占位累及眼眶及颅底。行鼻活组织检查,标本送病理检查,最终诊断为嗅神经母细胞瘤继发左眼眶尖综合征。患者放弃治疗后半年去世。结论嗅神经母细胞瘤可以眼部症状为首发症状而就诊于眼科,眶尖综合征需要考虑鼻部占位病变,早期行CT或MRI等影像学检查及病理检查,有助于鼻源性眶尖综合征的早期病因诊断。

关键词: 眶尖综合征, 病因, 早期诊断, 上睑下垂, 鼻恶性肿瘤

Abstract: Objective To investigate the etiology and early diagnosis of orbital apex syndrome as the initial symptom caused by sinus disease. Methods The medical records of a 74-year-old female patient were reported. She presented with "bilateral upper eyelid ptosis with visual disturbance for more than 4 months, the left eye being more severe", and the patient underwent surgical correction of the left upper eyelid ptosis, which was successful. Two weeks later, the patient presented with decreased vision in the left eye, accompanied by eye pain and headache, and was readmitted for further evaluation. Results The left eye was fixed anteriorly with limited ocular movement in all directions. The left eye was papillary hyperemic and oedematous, with scattered haemorrhages and cotton wool spots at the posterior pole. Orbital and cranial MRI and paranasal sinus CT showed nasal involvement of the orbit and skull base. Nasal biopsy specimens were obtained and sent for pathology, and the final diagnosis was olfactory neuroblastoma secondary to left orbital apex syndrome. The patient died six months after stopping treatment. Conclusion Olfactory neuroblastoma can be found with ocular symptoms as initial symptom. Nasal space occupying lesions should be considered in orbital apex syndrome. Orbital, cranial and paranasal sinus CT or MRI and pathological examination are helpful in the early etiological diagnosis of orbital apex syndrome.

Key words: Orbital apex syndrome, Etiology, Early diagnosis, Ptosis, Nasal malignant tumor

中图分类号:

R777.5

彭宇婷,李坚昊,王燕. 鼻-眼眶-颅底恶性肿瘤继发眶尖综合征1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 105-111.

PENG Yuting, LI Jianhao, WANG Yan. Orbital apex syndrome secondary to nasal-orbital-skull base malignant tumor: a case report and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(5): 105-111.

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