鼻内镜视神经减压术治疗外伤性视神经病与VEP的诊断价值

目的探索鼻内镜下视神经减压术的疗效及影响疗效的相关因素。方法外伤性视神经病37例,在外伤后3～30d内行鼻内镜下视神经减压术。13例病人术前和术后行FVEP检查。结果37例病人中21例术后视力获得改善,有效率为56.8%。13例术前和术后行FVEP监测中,能引出P100波的患眼术后疗效好于无P100波者(P<0.005)。结论外伤性视神经病应积极采用视神经减压术,手术后疗效与视神经的损伤程度密切相关,似并不完全取决于伤后时间。术前FVEP检测情况对预测预后有一定的帮助。

The transnasal endoscopic optic nerve decompression used in traumatic optic neuropathy and diagnostic value of VEP

Objective To explore an optimal method to treat traumatic optic neuropathy with transnasal endoscopic optic decompression, and to study the VEP influential factors of surgical effect. Methods Thirty-seven patients (37 eyes) with traumatic optic neuropathy were enrolled. Transnasal endoscopic sphenoethmoidal optic nerve decompression was performed within 30 days after injury. Thirteen patients were checked by VEP examination before and after surgery. Results Among 37 patients, the final visual acuity improved in 21 ( 56.76%). The patients with presence of P-100 wave in VEP had better improvement in visual acuity than those without the wave (P< 0.005). Conclusion The optic nerve decompression should be done after the failure of treatment with high dose of steroid. The key factor determining the nerve recovery is more likely correlated with the severity of optic nerve trauma, but not completely with the days before surgery. The preoperative F-VEP may be considered as a marker associated with prognosis.