Study On Preoperative Histological Judgment And Treatment Of Orbital Schwannoma

Objective Orbital schwannoma is mostly benign tumor,patients visite hospital with prominent eye,vision loss,eye movement or diplopia and so on,the general intraorbital tumor can cause these changes,it isn't easy to identify the tumor with others.The tumor growth position changes,extracapsular membrane is extremely thin,the residual tumor cells will lead to tumor recurrence.The purpose of this study make histological judgments through clinical and imaging analysis,develop the best surgical program and get best prognosis according to the location and scope of the tumor.Methods Retrospectively reviewed the clinical manifestations,imaging features and accessed relevant literatures to analyze and summarize the clinical characteristics of the disease.Summarize these cases and learn the treatment of the disease from home and abroad to explore the best treatment of the disease.Results 1.The patients visited doctors with eye progressive proptosis mostly.The typical clinical manifestations were proptosis,decreased vision,palpable masses and eye movement disorders.2.B mode ultrasonography examined the internal echo was uneven,which accounter for 57.00%.CDI examination showed a variety of blood flow distribution.CT showed the location was extensive,mainly at the top and outside,often involving 1/3 of the after orbital.The shape was various,mainly for long strip and quasi circular.MRI examination showed there were abundant internal signals,especially T2 WI image with low,middle and high mixed signals.3.There were 89 of anterior orbitotomy,110 of lateral orbitotomy,9 of medial orbitotomy,5 of combined lateral,5 of medial orbitotom exenteration of the orbit and 4 of transcranial surgery.The patients who underwent lateral orbitotomy had a greater risk of ptosis,decreased vision and eyemovement disorders than those who underwent anterior orbitotomy.There was more esidual tumor for who underwent anterior orbitotomy of involving the 1/3 of the after orbital,but not difference for not involving.4.The malignant tumor should be highly suspected when the tumor grouing rapidly,the obvious pain,and the orbital bone wall destroyed.The anterior orbitotomy was used for the benign tumor not involving the 1/3 of the after orbital,and lateral orbitotomy for involving.Conclusion The majority of orbital schwannomas could be determined by imaging examination before surgery.B mode ultrasonography showed less and less internal echo of the tumor,solid tumors showing a few small pieces or into a film through the area,should be highly suspected as orbital schwannoma.CT showed that the tumor growing beaded,gourd-like,or long strip,long oval paralleling to the axial,mostly were orbital schwannomas,could be diagnosed combined spreading to cavernous sinus by superior orbital fissure.Dumbbell shape should also be highly suspected schwannoma when cranio and orbital communicating tumor,dumbbell middle part in superior orbital fissure,both ends in the orbital and cavernous sinus area,orbital apex bone was not thickened or missing.MRI T2 WI showed tumor with low,medium and high mixed signal could be sure for the orbital schwannoma combining tumor special shape,such as beaded,long strip,dumbbell shape.Patients got anterior orbitotomy with not involving the 1/3 of the after orbital,lateral orbitotomy was used involving.But if the location was closed to the inside or large volume,could combined with lateral.Cranio and orbital communicating tumos could use transcranial surgery.Benign tumors wre usually treated with local resection of tumors,and malignant tumors needed to be expanded or medial orbitotom exenteration of the orbit.