眼外肌的断层解剖学研究

目的：为眼外肌疾病及其并发症的诊断及治疗提供形态学资料。方法：将低温冷冻的固定健康成人眼眶沿标志线以０．５ｃｍ层厚,利用国产ＭＪ－３４６Ｂ型电动带锯铸连续断层．结果：观察和测量了正常人眼外肌在眶尖平面至眼球后极５个连续断面上的宽、厚、横断面积及其与视神经、眶壁的位置关系。结论：眼外肌正常位置及此５个断面上的一些测量值在斜视和眼型Ｇｒａｖｅｓ’病的严重并发症－视神经病变的诊断中有重要应用价值。     

肌圆锥断层解剖学研究

目的:为肌圆锥间隙疾病及眼型Graves病影像学诊断提供形态学基础.方法:在15个防腐固定成人尸头的颅前窝底上作9个连续冠状断面,观测眼球后第2～5断面眼直肌的宽、厚、断面面积和距离.结果:在第2～5断面上,眼直肌断面面积之和与相应眶断面面积的比率分别为:(20±3)%、(27±2)%、(23±3)%、(13±1)%.水平肌厚度之和与相应眶宽的比率分别为:(36±4)%、(39±5)%、(33±5)%、(24±4)%.结论:在第3断层上利用此两个比值可预测眼型Graves病视神经病变发生的可能性.眼眶冠状断面可反映眶内各间隙之间的关系,可为影像学诊断肌圆锥间隙疾病提供形态学资料.     

眼外肌正常人厚度的B型超声测定

<正> 眼外肌是维持眼球正常位置和运动的重要因素,当眼外肌发生病变时,眼外肌常有解剖结构的改变,所以我们对于正常的眼外肌进行结构正常测量有其一定的重要意义,本文采用B型超声诊断仪对20例(40眼)进行正常人测量,报告如下:     

眼眶特发性炎性假瘤的相关影像学鉴别诊断

目的探讨眼眶特发性炎性假瘤与眶内其它常见占位性病变的影像学(CT及MRI)鉴别诊断要点。方法回顾分析80例IOIP患者的临床及CT及MRI资料,同时筛选出同时期其它眶内常见占位性病变97例,将它们与IOIP进行有针对性的比较,探讨不同类型IOIP与眶内常见占位性病变影像表现的异同点。结果①肌炎型IOIP与甲状腺相关眼病在性别、眼别、眼外肌边界、肌腱受累、外直肌受累频率及眶尖脂肪存在方面差异有统计学意义(P<0.05)。②肌炎型IOIP与颈动脉海绵窦瘘在眼外肌边界、肌腱受累、肌肉肿胀程度及眶尖脂肪存在方面差异有统计学意义(P<0.05)。③肿块型IOIP与海绵状血管瘤及神经源性肿瘤在病灶形态、边界、密度(信号)、T_2信号强度、强化程度、"铸型"征、邻近组织受累及眶尖脂肪存在方面差异有统计学意义(P< 0.05)。④泪腺炎型IOIP与泪腺混合瘤在眼别、眼睑肿胀、泪腺形态、边界、密度、"铸型"征及眶骨改变方面差异有统计学意义(P<0.05)。⑤泪腺炎型IOIP与(表)皮样囊肿在就诊年龄、眼别、眼睑肿胀、疼痛、病变形态、边界、密度、负值区、"铸型"征及眶骨改变方面差异有统计学意义(P<0.05)。⑥巩膜炎及视神经炎...     

Graves眼病的CT和MRI影像学分析

目的 :评价 CT、MRI在 Graves眼病诊断中的价值。方法 :回顾性分析 36例经临床和 (或 )实验室检查诊断 Graves眼病的 CT扫描、MRI等临床资料。结果 :眼球突出 2 9例 ,眼外肌肿胀 36例、眶尖眼外肌增厚 14例 ,视神经增粗 6例、眼上静脉扩张 2例、泪腺肿大 1例。结论 :CT、MRI检查可做为Graves眼病诊断的重要依据。     

眶内特发炎性假瘤23例CT诊断

目的探讨CT扫描对眶内特发炎性假瘤的诊断价值。方法回顾性分析23例眶内特发炎性假瘤患者的CT表现。结果CT征象主要有：眼球突出16例,眼环增厚9例,泪腺肿大8例,眼外肌增粗14例,眶内脂肪密度增高6例,合并鼻窦炎4例。可分为：弥散型、肿块型、泪腺炎型和肌炎型。结论CT扫描对眶内炎性假瘤的诊断有重要价值并能指导临床治疗。     

经眼上静脉行海绵窦动静脉瘘栓塞的显微解剖学研究

目的：为经眼上静脉行海绵窦动静脉瘘栓塞提供显微解剖学依据。方法：选用２０例成人头颅湿标本,在可放大５～２５倍手术显微镜下解剖、观察、测量眼上静脉的走行及相关解剖参数。结果：眼上静脉由眶上静脉的眶上支和内眦静脉的交通支汇合而成,在肌锥内向后行走。到达眶尖时,从上、外直肌间穿出肌锥,然后向内向下绕行,经腱环外侧沿眼神经和外展神经下边汇入海绵窦。结论：熟悉眼上静脉显微解剖关系可以很好地指导经眼上静脉行海绵窦瘘栓塞治疗。     

眼眶炎性假瘤的CT诊断与鉴别诊断

目的:探讨各种类型眼眶炎性假瘤的CT表现,提高对该病诊断和鉴别诊断水平.方法:回顾性分析32例经手术病理或临床证实的眼眶炎性假瘤的CT资料.结果:肿块型,占15.6%(5/32),CT表现为眶内软组织肿块:弥漫型,占34.4%(11/32),CT表现为充满眶内球后区软组织影,眶内结构分界不清;肌炎型,占37.5%(12/32),CT表现为眼外肌受累增粗,肌腱肥大;泪腺型,占12.5%(4/32),CT表现为泪腺肿大.结论:CT在眼眶炎性假瘤的诊断和鉴别诊断中具有重要作用.     

眶尖区外伤CT和MRI的诊断及比较

目的:探讨64排CT和1.5TMRI在诊断眶尖区外伤的价值。方法:53例眶尖区外伤病例行64排CT和1.5T MRI检查。结果:64排CT显示本组眼眶壁全部骨折,视神经损伤32例,眼外肌损伤37例,球后血肿12例。1.5T MRI显示视神经损伤47例,眼外肌损伤51例,球后血肿11例。结论:1.5TMRI检查对外伤性视神经和眼外肌损伤等软组织损伤优于64排CT检查,而64排CT检查对眶壁骨折优于1.5TMRI检查。     

Graves眼病的CT影像分析

目的 探讨CT扫描对Graves眼病的临床诊断价值.方法 回顾性分析27例经临床证实的Graves眼病的CT影像资料.结果 Ⅰ度眼球突出41眼,Ⅱ度眼突6眼,正常7眼.双眼外肌受累20例,单眼外肌受累7例;眼内直肌受累38条,下直肌31条,上直肌21条,外直肌12条,视神经增粗8条.泪腺肿大4例,眶内脂肪密度增高7例,眼上静脉增粗6例.结论 眼眶CT扫描能定量反映眼球突出情况,明确眼外肌肥大及其周围组织结构改变,为临床诊断和治疗Graves眼病提供可靠依据,对其早期诊断具有重要意义.     

Normative Measurements of Extraocular Musculature by Multislice Computed Tomography

Objective To establish the normal measurements of diameter of extraocular muscles (EOMs) by multislice computed tomography (CT). Methods Orbits of 50 volunteers (25 male and 25 female) were scanned with a multislice CT scanner. For each subject, one axial image at the central level of the eyeball, one coronal image about 1 cm behind globe, and two oblique sagittal images respectively along the left and right optic nerve were used for measurements of the thickness and width of EOMs. The statistic significance of measurement value between male and female and between left and right eyes was evaluated. Results There were no significant differences in the thickness and width of superior muscle group, lateral rectus, medial rectus, lateral rectus, superior oblique, inferior oblique and the thickness of levator palpebrae superioris between the left and right eyes as well as between male and female groups (all P>0.05). The thickness of superior muscle group and inferior rectus had not significant difference (2.9±0.7 vs. 3.3±0.8 mm, P=0.162), while the thickness of medial rectus was significantly higher than that of lateral rectus (3.1±0.5 vs. 2.2±0.6 mm, P=0.000). Conclusions The CT measurement of extraocular musculature is simple and time-saving and can be applied in the clinical work. The normative data obtained may be useful in determining pathologic enlargement of the EOMs in both thyroid-associated orbitopathy patients and other various orbital conditions.     

Manage orbital apex lesions via posterior lateral orbitotomy

Background: Technically it is most challenging to reach orbital lesions located in the apex. We intend to show that posterior lateral orbitotomy is a valid and effective surgical approach to manage orbital apex lesions. Methods: Posterior lateral orbitotomy was performed on 9 patients, including 4 males and 5 females, who were diagnosed with orbital apex tumors located lateral to optic nerves. Results: For the 9 patients diagnosed with orbital apex lesions, the apical tumors were accessed and resected via posterior lateral orbitotomy. En bloc resection of apical lesions was achieved in 7 patients, whereas subtotal resection was done in 2 patients whose tumors were too close to the surrounding vital structures. There is no mortality, postoperative ptosis or lateral rectus disorder. Exophthalmos symptoms disappeared completely after the surgery, and visual acuity or visual field was improved in most patients. Conclusion: Posterior lateral orbitotomy is a valid and reliable alternative for extraorbital approaches in managing the orbital apex lesions as it provides sufficient exposure to the lesions and incurs minimum cosmetic defects and damages to normal tissues.     

经颅—眶缘眶板开眶术——介绍一种新的经颅开眶途径

对5例眶内肿瘤患者采用新的经颅开眶入路。本手术对于眶内肿瘤、尤其当肿瘤位于眶中部、眶内侧部或眶尖部(肌锥内时),能获得清晰而宽大的视野,可在直视下暴露从球后至视交叉的视神经,必要时可作视神经管扩大术,眶内神经与眼肌的损伤轻微。手术在硬脑膜外操作,骨瓣复位良好,术后无搏动性眼球震颤和颅内感染等并发症。作者认为本方法优于传统的Dandy氏法。     

眶颅沟通性肿瘤的MRI诊断价值

目的:探讨MRI对眶颅沟通性肿瘤性病变的显示能力及其临床价值。方法:45例患者,男20例,女25例。发病年龄4～66岁,平均41岁。均经手术及病理证实。所有病例均行MRI普通扫描,其中15例行强化扫描。结果:本组资料MRI显示眶颅沟通性肿瘤常有4个沟通渠道。其中18例经视神经管沟通,包括视神经胶质瘤8例,视神经鞘脑膜瘤8例,视网膜母细胞瘤2例,侵犯视交叉及海绵窦。通过眶上裂沟通14例,神经鞘瘤6例,视神经鞘脑膜瘤6例,炎性假瘤2例,侵犯同侧海绵窦。通过眶下裂沟通5例,神经鞘瘤5例,侵犯同侧海绵窦。经过眶壁骨质缺损与颅内沟通8例,有皮样囊肿2例,泪腺腺样囊性癌4例,蝶骨脊脑膜瘤2例。结论:MRI平扫及增强扫描能明确显示眶颅沟通性肿瘤的沟通路径,为临床治疗提供重要和直接的依据。     

Magnetic resonance imaging of the extraocular muscles and corresponding cranial nerves in patients with special forms of strabismus

Background With the technical advances, magnetic resonance imaging （MRI） is now sensitive enough to detect subtle structural abnormalities of ocular motor nerves arising from the brainstem and orbits of living subjects. This study was designed to delineate the MRI characteristics in patients with special forms of strabismus. Methods A total of 29 patients with special forms of strabismus underwent orbital and intracalvafium MRI. Imaging of the ocular motor nerves in the brainstem was performed in 0.8 mm thickness image planes using the three-dimensional fast imaging employing steady-state acquisition （3D-FIESTA） sequence. Nerves to extraocular muscles （EOMs）, EOMs and their associated connective tissues were imaged with T1 weighting in tri-planar scans by dual-phased coils within 2.0 mm thick planes. Results Patients with congenital fibrosis of the extraocular muscles exhibited hypoplasia of the oculomotor （CN3）, abducens （CN6）, trochlear （CN4） nerves, and the EOMs; hypoplasia of CN6 in the brainstem and an extra branch of the inferior division of CN3 to the lateral rectus were the most common but not the only presentation of Duane＇s retraction syndrome. Hypoplasia of CN6, facial （CN7） and hypoglossal （CN12） nerves were revealed in patients with MSbius syndrome. In a rare case of bilateral synergistic convergence and divergence, an enlarged branch of CN3 to the medial rectus and a questionable branch of CN3 to the inferior rectus bilaterally were found. Conclusion MRI can reveal subtle structures of the ocular motor nerves and their corresponding EOMs. This can provide valuable information regarding pathogenesis in some special forms of strabismus.     

Megnetic resonance imaging findings in sporadic Mobius syndrome

Background Although neuroradiological findings of M(o)bius syndrome have been reported as a result of brain and brainstem abnormalities,magnetic resonance imaging (MRI) now permits the direct imaging o...     

影像学检查在眶颅沟通性肿瘤诊断中的价值

目的 探讨眶颅沟通性肿瘤病变的超声、CT和MRI的影像学表现特征,从而为眶颅沟通性肿瘤的准确诊断提供辅助信息.方法 1998年1月～2011年12月就诊于我院60例患者,男28例,女32例.发病年龄5～70岁,平均45岁.均经手术及病理证实.所有病例术前均行超声检查,CT扫描,MRI普通扫描,其中20例行MRI强化扫描.结果 本组资料影像学检查显示眶颅沟通性肿瘤常有3个沟通渠道.经过视神经管沟通20例,包括视神经胶质瘤8例,CT示肿瘤呈哑铃形,MRI对视神经胶质瘤的显示具有特异性;视神经鞘脑膜瘤8例,CT显示双轨征,增强后显示更明显;视网膜母细胞瘤4例,侵犯视交叉及海绵窦,CT表现为含高密度钙化的肿块,视神经增粗.经过眶上裂沟通17例,神经鞘瘤6例,MRI显示T1WI上呈中低信号,T2WI上呈高信号,不均匀强化,无强化区较具特征性;视神经鞘脑膜瘤8例,CT及MRI显示同视神经管沟通途径;特发性眼眶硬化性炎症3例,侵犯同侧海绵窦,MRI显示肿块在T1WI呈略低信号,T2WI呈低信号,增强后明显增强.经过眶壁骨质缺损与颅内沟通23例,有皮样囊肿5例,蝶骨脊脑膜瘤4例,泪腺腺样囊性癌6例,眶壁转移瘤8例.CT可较好的显示眶壁骨质的破坏,MRI可较好的显示肿瘤的颅内转移.结论 在眶颅沟通性肿瘤的影像学检查中超声、CT、MRI各有特点,综合运用超声、CT和MRI等影像学检查方法可提高诊断和鉴别诊断水平,为临床治疗提供重要和直接的依据.     

眶部经颅手术入路显微解剖学研究

目的 为经颅至眶部手术入路提供详细的显微解剖学依据及解剖参数。方法 应用２０例成人头颅湿标本,在放大５￣２０倍显微镜下,对眶内手术入路进行显微解剖分析及测量。结果 内侧入路是经上斜肌与提上睑肌之间的间隙,经此入路可切除眶尖区内侧病变。中央入践是经提上睑肌与上直肌之间的间隙,根据额神经牵向内侧还是牵向外侧分为两种术式;经此入路可行眶内段视神经中段病变的切除。外侧入路是经上直肌与外直肌之间的间隙,根据     

眼眶炎性假瘤CT初步评价

眶内炎性假瘤的CT研究少见报道。本研究对经临床、手术和病理证实的4例眼内炎性假瘤的CT扫描进行初步分析。结果表明：眶内炎性假瘤之CT表现主要有眶内局限软组织肿块，眼外肌增粉和眼环增厚，并有球后脂肪间隙模糊和视神经增组等辅助征象。多数病例为几种征象并存。本文对鉴别诊断作了讨论。