手术治疗间接性视神经损伤19例

目的 探讨颅脑损伤合并视神经损伤的有效治疗方法。方法 手术治疗１９例颅脑损伤合并视神经损伤病人，其中无光感１１例，光感６例，眼前手动１例，眼前数指１例。１６例行额部冠状切开头皮，一侧额部开颅清除眶骨骨折片或出血，矫正额眶骨折错位畸形。有视神经管骨折者，用微钻磨开视神经管，剪开视神经鞘进行神经减压。３例眶尖综合征者行额颞切口，经眶尖外侧壁磨开眶上裂和视神经管神经减压。结果 １２例有效，其中３例眼球突

Surgical treatment of 19 cases of optic nerve injuries

Objective To study surgical effect on optic nerve injury after head injury. Methods There were 19 patients who sustained optic nerve injuries after head injury, of which 16 underwent transfrontal craniotomy of bicoronal skin flap which cleaned out fragment and debridement of hemorrhage and stabilized displacement of orbital fracture. The supra-wall of the optic canal was drilled and the optic sheath was opened with longitudinal incision in the relative avascular region. The transfrontotemporal craniotomy was performed in 3 patients with supraorbital syndrome to remove bony fragments, decompress hemorrhage and open optic nerve sheath. Results The follow-up for all patients varied from 1 month to 12 months. Of 16 patients, 12 were cured of visual acuity, 3 exophthalomus and 1 enophthalomus. Conclusions The tansfrontal and frontotemporal approach may be an effective treatment for traumatic optic neuropathy after head injury.