颅脑外伤合并视神经损伤

目的 探讨颅脑外伤合并视神经损伤的诊断、治疗方法,评价其治疗后的视力恢复情况.方法 对25例(25眼)颅脑外伤合并视神经损伤患者中20眼行非手术保守治疗,5眼进行视神经管减压手术.结果 视神经损伤保守治疗20眼中,13眼视力不同程度提高;5眼进行视神经管减压手术3眼视力提高.结论 对颅脑外伤合并视神经损伤的诊断、治疗要足够重视;在救治颅脑外伤的同时,应注意观察、抢救视神经损伤,挽救残余视力.有手术指征者要争取时间尽早进行视神经管减压术.     

外伤性视神经病变临床分析

目的 探讨外伤性视神经病变的诊断方法及治疗效果。方法 回顾32例35眼视神经损伤的诊断，手术治疗和药物治疗后的视力恢复情况。进行总结分析。结果 视神经损伤7天之内就诊者，无光感15眼仅2眼视力提高，光感以上者16眼视力均有不同程度的提高。8-20天就诊者，1例（2眼）无变化，2例行视神经管减压术视力提高。结论 外伤性视神经病变以CT检查有视神经受压迫的阳性征象者，不论有无光感均应及早手术；无阳性征象者及早药物治疗，多途径给药，效果较好。伤后立即失明者治疗效果差。     

外伤性视神经病变临床分析

目的 探讨外伤性视神经病变的诊断方法及治疗效果。方法 对36例39眼视神经损伤的诊断、手术治疗和用药后的视力恢复情况，进行总结分析。结果 视神经损伤7天之内就诊者，无光感16眼仅3眼视力提高，光感以上者17眼视力均有不同程度的提高。8—20天就诊2例(4眼)无变化，2例行视神经管减压术视力提高。结论 外伤性视神经病变经CT检查有神经受压迫的阳性征象者，不论有无光感均应及早手术，无阳性征象者及早用药治疗多途径给药，效果较好。伤后立即失明者治疗效果差。     

颅脑外伤与视神经损伤

目的探讨颅脑外伤后所致视神经损伤的治疗方法和预后。方法对22例（22眼）颅脑外伤致视神经损伤的原因、治疗与结果进行统计分析。结果视神经损伤经治疗后视力有不同程度提高，但效果不良，无光感者占22．72％。结论对颅脑外伤所致视神经损伤应早期发现、及时治疗。     

颅脑外伤合并视神经损伤26例早期诊疗分析

目的探讨颅脑外伤合并视神经损伤的早期诊断与治疗方法。方法颅脑外伤合并视神经损伤26例（28眼）。根据颅脑外伤史,视力严重障碍,相对性瞳孔传人障碍。早期进行眼眶X线拍片,头颅CT或MRI检查,视觉诱发电位检查。治疗用甘露醇,甲泼尼龙,能量合剂,脑活素,胞二磷胆碱,维生素C及高压氧。结果追踪观察3个月,28眼中有21眼视力有改善。结论及早诊断和及早治疗极为重要。24h以内是治疗外伤性视神经病变的最佳时机。     

外伤性视神经病变26例临床分析

目的探讨外伤性视神经病变的诊断方法及治疗效果。方法对5年间收治的26例（28只眼）视神经损伤患者的临床特点与治疗效果进行总结分析。结果无光感21只眼有5只眼视力提高,光感以上7只眼均有不同程度提高。6只眼行视神经管减压术,其中2只眼仍无光感,4只眼视力提高。结论外伤性视神经病变多见于车祸头部外伤后,应尽早用大剂量糖皮质激素和脱水剂及血管扩张剂等治疗,早期视神经管减压术效果好。伤后立即失明者效果差。     

开颅视神经管开放减压术治疗颅脑外伤并视神经损伤

急性颅脑外伤合并视神经损伤是神经外科急症和常见病 ,由于专业的局限 ,以往视神经损伤被忽视 ,导致视神经损伤遗漏。我院神经外科与华北煤炭医学院附院眼科结合 ,于 1996年3月至 1999年 8月 ,对 8例脑外伤合并视神经损伤经开颅视神经管开放减压、视神经鞘切开手术 ,术后视力恢复良好 ,现报告如下。　　一、临床资料8例中男 7例 ,女 1例 ,年龄 18～ 45岁。平均 33.8岁。均为中度颅脑损伤 ,GCS10～ 12分 ,6例为车祸伤 ,2例为高处坠落伤。8例病人均意识清楚 ,患眼视力下降 ,其中 4例视力 0 .2 ,3例光感～ 0 .0 1,1例无光感。患眼瞳孔中度或…     

颌面外伤并发间接性视神经损伤治疗的探讨

目的 探讨颌面外伤并发间接性视神经损伤的治疗效果。方法 46例颌面外伤并发间接性视神经损伤一经确诊，早期采用皮质类固醇冲击疗法、脱水剂、血管扩张剂、光量子血液疗法、维生素B族、神经营养剂等治疗。结果 46例(54眼)中治疗前无光感的5眼经治疗后3眼视力改善；治疗前光感的22眼经治疗后19眼视力提高。治疗前视力0．05～0，1者4眼，治疗后增至5眼；治疗前视力0．4～0．6者4眼，治疗后增至8眼；治疗前视力0．6以上者1眼，治疗后增至15眼。结论 间接性视神经损伤早期药物治疗是必要的，且有较好效果。     

间接视神经损伤28例临床分析

目的 探讨间接视神经损伤的临床特征,分析药物、手术治疗效果。方法 经颅视神经管减压治疗１眼,大剂量甲基强的松龙冲击加尼可林治疗２７眼。结果 视神经管减压治疗１眼,术后视力由无光感增至０．２,药物治疗２７眼,无光感组１１眼中１０眼无效,光感或有残存这高力组且２４小时以内及时治疗９眼中８眼有效。结论 早期及时皮质类固醇冲击加尼可林治疗有残存这高力的间接视神经损伤有效可行。     

眶尖部硬膜外血肿致视神经损伤临床分析

目的 探讨眶尖部硬膜外血肿压迫引起视神经损伤的诊断与治疗.方法 回顾性分析13例(14眼)眶尖部硬膜外血肿压迫引起视神经损伤的患者,患者视力:无光感～0.7,其中无光感1眼,光感(+)3眼,0.06者3眼,0.08者1眼,0.3者2眼.0.4者1眼,0.5者2眼,0.7者1眼.所有患者均采用药物疗法,其中6例6眼患者还采用手术治疗.观察所有患者治疗后视力变化.结果 所有患者治疗后视力都有明显改善.治疗后视力:光感(+)～1.2,其中光感(+)1眼,眼前手动1眼,数指/40 cm 2眼,0.4、0.5、0.6、0.7、0.8、1.1和1.2者各1眼,1.0者3眼.仅采用基础治疗患者视力:光感(+)、眼前手动、数指/40cm者各1眼,余5眼平均视力0.7;基础治疗联合手术治疗患者视力:数指/加cm者1眼,余5眼平均视力0.96.结论 眶尖部硬膜外血肿压迫引起的视神经损伤,属于间接损伤,早期诊断、治疗减轻或解除压迫可明显改善视力.     

Indirect traumatic optic neuropathy--visual outcome of operative and nonoperative cases

From 1968 through 1984, 110 cases (113 eyes) with indirect traumatic optic neuropathy were seen at the Department of Ophthalmology and Otorhinolaryngology of the Kobe University Hospital; 43 eyes were treated nonsurgically with steroid and 70 eyes were operated on by the endonasal-transethmoidal method of optic canal decompression. By comparison of the visual improvements in the two groups, the effectiveness of the surgical treatment was evaluated. In the nonsurgical group, 19 eyes showed a visual improvement, giving an overall improvement rate of 44.2%. In 9 eyes with complete visual loss at the initial visit no visual improvement could be seen. In 34 eyes with the vision better than light perception at the initial visit, vision improved in 19 eyes, ie, the improvement rate was 55.9%: the recovery occurred relatively rapidly within 3-4 weeks, and thereafter the condition remained unchanged. In 30 eyes treated within 3 weeks after trauma, 17 eyes (57%) showed visual improvement, but in 13 eyes where treatment started after 3 weeks, improvement was seen only in 15%. In the surgical group, 34 eyes showed a visual improvement; the overall rate of improvement was 47.7%. In 28 eyes where complete visual loss was seen at the first visit, 7 eyes showed visual improvement. In 38 eyes treated within 3 weeks after trauma, 18 eyes (45%) showed visual improvement, and in 32 eyes where the surgery was performed after 3 weeks, 16 eyes (50%) showed improvement. The latter improvement rate was significantly higher (P less than 0.05) than the improvement rate of 15% found in eyes of the nonsurgical group, where the treatment started 3 weeks after trauma. In cases with indirect traumatic optic neuropathy, surgical decompression of the optic canal can give a visual improvement even when complete visual loss is found in the early period. The surgery is effective in cases where visual recovery by conservative treatment is not satisfactory after 3 weeks. On this basis the criteria for surgical treatment were determined: when the vision is better than light perception in the early period, conservative treatment must first be given, but surgery is indicated when the vision does not improve to 0.5 or better within 3 weeks. In cases where complete visual loss is found soon after injury, earliest possible surgical intervention is recommended.     

外伤性视神经病变经鼻内镜下视神经管减压及综合治疗

目的 回顾外伤性视神经病变经鼻内镜下视神经管减压合并药物治疗的结果,探讨手术适应证.设计回顾性病例系列.研究对象2006年～2010年北京同仁医院耳鼻咽喉头颈外科收治的外伤性视神经病变患者69例（69眼）.方法 患者术前均行视神经管CT检查,除外严重颅脑外伤合并症,行鼻内镜下经筛、蝶窦视神经管减压术,同时给予围手术期激素冲击、营养神经及扩张血管等综合药物治疗.主要指标手术后视力.结果 59例（85.5%）术前CT扫描显示视神经管骨折.67例（97.1%）行视神经管减压术,其中因鞘膜水肿或鞘膜下积血切开神经鞘2例 1例放弃手术 另1例视力自行恢复出院.随诊2～44个月,术后视力改善30例（44.8%）,其中从无光感到有光感18例,视力大于0.1者9例.结论 经鼻内镜视神经管减压联合药物治疗是目前治疗外伤性视神经病变的推荐方法之一,在除外手术禁忌的情况下,应积极手术并结合药物治疗,挽救视力.     

High-dose steroid therapy of traumatic optic neuropathy may fail to protect the optic nerve permanently

Background: The optimal treatment of traumatic optic neuropathy (TON) is still unresolved due to the poor understanding of the pathology involved and the relatively small number of cases in the published clinical series. It is currently held that the results of conservative treatment with high-dose corticosteroids are similar to those obtained with surgical decompression. Purpose: To assess the late results of conservative treatment for traumatic optic neuropathy. Patients and methods: 15 patients (3 women and 12 men, age 14–64 years) who sustained a direct injury to the optic nerve as a consequence of closed head trauma. All were treated conservatively with high-dose dexamethasone therapy. Ten patients presented for follow-up examination 3–11 years after the injury, on average 5.3±2.4 years (SD). A full ophthalmologic examination and color-coded Doppler (CCD) study of the orbital vessels was performed in all subjects. Results: Full blindness of the affected eye, persisting since the injury, was noted in six patients. Their visual acuity did not improve in spite of vigorous treatment and their eyes remained without sight at the follow-up examination. The finding of an absence of flow in central retinal arteries at follow-up suggests structural damage to the nerve. Moreover, in five of these patients, distinct features of eyeball atrophy had evolved between the time of injury and the follow-up examination. Four patients, who on admission presented only with the ability to perceive light, responded to 2–3 weeks of steroid therapy with improvement of visual acuity to 3/50, 5/50, 5/10, and 5/7. After 4–6 years, however, the visual acuity of all of these patients had deteriorated, resulting in nearly total blindness in one case, light perception in two, and 1/50 in the fourth. Optic nerve atrophy was diagnosed in all of the affected eyes. Conclusion: Conservative treatment of TON, even if giving transient improvement in visual function, may not be reliable in providing permanent relief from the sequelae of traumatic optic neuropathy.     

管内段视神经间接损伤20例疗效分析

目的 评价视神经鞘减压术的疗效。方法 ２０例管内段视神经间接损伤患者（视力光感者３例,无光感者１７例）５例施视神经管减压开放术,９例施视神经鞘减压术,６例拒绝接受手术,使用药物治疗。结果 ５例视神经管减压开放术,治疗效果均不明显。９例视神经鞘减压术中,３例治疗效果显著。６例药物治疗者,治疗效果均不明显。结论 视神经鞘减压术治疗管内段视神经间接损伤,此方法有效可行。     

间接性视神经挫伤晚期无光感眼治疗分析

目的:探讨复方樟柳碱联合苏肽生治疗间接性视神经挫伤晚期无光感眼的治疗情况。方法:回顾性分析复方樟柳碱联合苏肽生治疗间接性视神经挫伤晚期无光感眼11例的治疗临床特点和结果,根据治疗结果分为有效组和无效组。结果:经过治疗后视力提高4眼。非熄灭型F-VEP和视力下降至无光感的时间在两组之间具有统计学差异。结论:间接性视神经挫伤晚期无光感眼,视力下降至无光感的时间长、非熄灭型F-VEP波形者,可积极治疗,复方樟柳碱联合苏肽生是一种有效的治疗方法,。     

严重眼雷管爆炸伤特点及玻璃体切割手术疗效观察

目的 观察眼球严重雷管爆炸伤的特点以及2期玻璃体切割手术治疗的效果。方法 回顾分析37例雷管爆炸伤患者65只眼的临床资料。男性36例,女性1例;平均年龄28.6岁。双眼伤31例,占83.8%;单眼伤6例,占16.2%。48只眼为严重爆炸伤眼,视力无 感9只眼,其中3只眼明显萎缩;光感28只眼;眼前手动4只眼;数指/33cm 7只眼。46只眼行玻璃体切割手术治疗,其中41只眼为严重爆炸伤眼。未行手术治疗的19眼中13只眼无玻璃体手术指征;6只眼因眼球萎缩或经济原因放弃手术治疗。就诊时间在伤后1周以内者7例,占18.9%;1周～1个月者13例,占35.2%;1个月以上者17例,占45.9%。手术后随访6个月～2年,平均随访时间8.6个月。结果 65只眼中结膜异物占66.2%;角膜异物占46.2%;玻璃体积血占70.8%;球内异物占69.2%。视网膜震荡伤或视神经冲击伤占56.9%。视力提高33只眼;不变25只眼;下降7只眼。46只玻璃体切割手术眼中,眼球内异物伤35只眼,占76.1%。视力提高26只眼,占59.5%;未提高13只眼,占28.3%;未治愈7只眼,占15.2%,其中眼球摘除2只眼,眼球萎缩5只眼。就诊时间超过1个月的患者手术后视力提高率低。单眼盲51.4%;双眼盲8.1%。结论 严重眼雷管爆炸伤大部为多发球内异物伤,就诊晚,伤情严重致盲率高,加强视网膜震荡和视神经冲击伤的诊治,尽早玻璃体切割手术可提高预后视功能。     

Orbital haemorrhage and prolonged blindness: a treatable posterior optic neuropathy.

Two patients developed traumatic orbital haemorrhage resulting in prolonged blindness. Orbital decompression successfully reversed the visual loss, though both eyes had no light perception for at least 3 1/2 hours. The clinical findings suggest damage to the posterior optic nerve as cause of the visual loss. The optic nerve tolerance time to ischaemic injury may be longer than previously thought.