额眶部骨纤维结构不良30例：三球法定位视神经管及临床效果评估

目的 研究额眶部骨纤维结构不良患者视神经管减压的适应证，以及术中视神经管定位和减压的方法。方法 收集我科骨纤维异常增殖病例共30例，术前进行充分的影像学评估，有症状者进行手术，包括眶部成型术和视神经管减压术。手术采用额颞硬膜外入路，如有凸眼则行经眶上缘入路。术中有6例进行了CT和MRI融合导航，协助寻找视神经的眶口或者颅口。术中使用三球法行视神经管减压，确认视神经位置。结果 视神经管减压30例，其中1例失明。患者视力和视野有不同程度改善，手术后凸眼消失或者改善。眶顶采用正常内板重建13例，钛板重建5例，未重建9例，2例用增生的碎骨铺于眶顶，但其中复发1例，表现为5年后再次出现眼球突出，而视力无下降。结论 额眶部骨纤维结构不良患者应积极手术治疗，视力下降应选择视神经管减压，合并面部畸形的同时做颅面部成型手术和眶减压术；硬膜外入路从眶口或者颅口定位视神经，结合三球法，可以做到安全且彻底的视神经管减压。

Thirty Cases of Front-orbital Fibrous Dysplasia: Intraoperative Optic Canal Localization with Three-bits Method and Outcomes Evaluation

Objective To investigate the indications of optic canal decompression in the patients with front-orbital fibrous dysplasia and the methods of intraoperative optic canal localization and decompression. Methods We collected 30 cases of fibrous dysplasia. All patients had sufficient images assessment. Patients with symptoms underwent surgery, including front-orbital cranioplasty and optic canal decompression. The frontotemporal epidural approaches were used. If there was a proptosis, the approach was extended with the removal of superior orbital ridge. Six patients undertook intraoperative CT and MRI fusion navigation, assisting in confirming the trunk, orbital and cranial orifice of optic nerve. During the operation, the optic canals were decompressed by three-bits method, to confirm the position of optic nerve. Results There were 30 cases of optic canal decompression and one case of vision loss. The visual acuity and vision field of the remaining patients improved to varying degrees. The proptosis disappeared or alleviated after the operation. Thirteen cases were reconstructed with normal internal plate, five cases with titanium plate, nine cases without reconstruction, and two cases were paved with proliferative broken bone on the orbital top; one case recurred with exophthalmos again after five years, but the visual acuity did not decline. Conclusion For the patients with front-orbital fibrous dysplasia, active surgical treatment should be taken, optic canal decompression should be chosen for diminution of vision, craniofacial anaplasty and orbital decompression should be performed in patients with facial deformity. The epidural approach is a good option to locate the optic nerve from the orbital orifice or cranial orifice. Combined with the three-bits method, we can achieve safe and meticulous optic nerve decompression.