摘要
目的探讨经鼻蝶内窥镜视神经管减压手术对视神经损伤病人的治疗效果。方法回顾性分析我病区收治68例单侧视神经损伤的病人，男性48例，女性20例，年龄17-58岁，所有病例均行经鼻蝶内窥镜视神经管减压手术，手术时间为伤后24h至47d。术前眼球活动障碍5例，患侧眼屈光间质、眼底及对侧眼视力均正常。术前CT见额眶骨骨折63例，未见明显骨折5例，筛窦纸板骨折59例，视神经骨管骨折31例，筛窦积血57例，窦积血29例。结果术后3个月随访观察，本组68例病人中56例术后视力有不同程度提高。12例12眼无效。5例术前眼球运动受限的患者，术后3例眼球运动恢复正常。结论内镜下经鼻视神经减压手术，具有入路短，微创，康复快的特点。而且，由于重力作用，视神经减压后会自然下垂，减压效果远远大于其他手术入路。术中还可以发现影像及其他检查未明确的骨折。总之，内窥镜手术视神经管减压有其独特的优点。
Abstract Objective The transsphenoidal endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy is discussed. Methods Between January 2013 and June 2014, 68 cases of traumtic optic neuropathy were admitted to our department at 1 h-47 d after trauna. All 58 patients （48 male and 20 female） ranged from 17-58 yeats. The pre-operative refractive interstitial, ftmdus and contralateral visual acuity were normal. Five casessuffered eyeball movement disorder. Pre-operative CT scanning revealed orbital frontal bone fracture in 63 cases, ethmoidal lamina papyracea fracture in 59 cases, optic canal fracture in 31 cases, while 5 cases had no fracture. The earliest time of operation was 24 h after injury, and the longest was 47 d after injury. Results During 3 months＂ follow-up, 56 eyes in 68 patients got improvement of visual acuity in different degree. However, 12 eyes in 12 cases were invalid. Among 5 cases of patients with pre-operative eye movement restriction and 3 cases got recovery post- operation. Condusion The transnasal endoscopic optic nerve decompression may be considered as a better approach for craniotomy with the advantages of short, minimally invasive and quick recovery. Moreover, the effect of optic nerve decompression was far greater than that of other surgical approaches. Therefore, endoscopic surgery of optic nerve decompression has its own unique advantages.
出处
《中华神经外科疾病研究杂志》
CAS
2015年第6期539-542,共4页
Chinese Journal of Neurosurgical Disease Research
关键词
内镜
颅脑损伤
视神经损伤
手术
Endoscopy
Craniocerebral trauma
Optic nerve injury
Operation
