大剂量激素治疗外伤性视神经病变的疗效及不良反应分析

目的：讨论大剂量糖皮质激素冲击疗法治疗外伤性视神经病变的疗效及不良反应。方法2008年～2013年收治的23例（23眼）外伤性视神经病变患者,应用大剂量甲基强的松龙或地塞米松冲击治疗,根据视力变化评价其疗效。结果视力提高≥0.1者12例;视力提高＜0.1者5例;视力无改善者6例,总有效率73.91％。结论大剂量糖皮质激素冲击疗法治疗外伤性视神经病变有较好疗效,治疗效果及预后与就诊时间有相关性。     

经颅视神经减压治疗已失明的外伤性视神经损伤

目的 探讨已失明的外伤性视神经损伤的手术效果.方法 回顾性分析8例颅脑损伤合并视神经损伤患者的临床特点,比较经颅视神经管减压手术前后的视力变化.结果 7例有视神经管骨折(7眼),1例无视神经管骨折(2眼);视神经挫伤并视神经鞘膜下出血1例(1眼),视神经缺血坏死1例(2眼),视神经轻度水肿6例(6眼).4例(4眼)术后1个月视力得到改善.结论 经颅视神经管减压治疗外伤性视神经损伤安全有效.     

全方位视神经管减压治疗无光感外伤性视神经损伤的疗效

目的 评估全方位视神经管减压治疗无光感外伤性视神经损伤(TON)的疗效。方法 选取2015年1月-2021年12月上海交通大学医学院附属第九人民医院神经外科收治的67例无光感TON患者的临床资料进行回顾性分析,其中观察组37例接受全程全方位视神经管减压手术治疗,对照组30例接受非全方位视神经管减压手术治疗。两组术前均接受大剂量糖皮质激素冲击治疗及甲钴胺口服治疗。检查并记录两组患者入院与治疗后的视力变化及并发症发生情况。比较两组治疗后的有效率、脱盲率和并发症发生情况。结果 观察组与对照组的年龄、性别、受伤至手术时间、术前格拉斯哥昏迷评分(GCS)分值、手术用时、术中出血量等比较差异均无统计学意义(P>0.05)。治疗后,观察组有效率54.1%、脱盲率35.1%,对照组有效率46.7%、脱盲率33.3%;两组有效率和脱盲率比较差异均无统计学意义(P>0.05)。两组术后均未出现脑脊液漏、癫痫、颅内感染等严重并发症。观察组中,视神经管骨折者治疗后有效率明显低于无视神经管骨折者(P<0.05);受伤至手术时间≤7 d的患者有效率明显高于受伤至手术时间>7 d的患者(P&...     

鼻内镜经蝶窦视神经减压术治疗视神经损伤临床分析

目的探讨鼻内镜下经蝶窦入路行视神经管减压术治疗创伤性视神经病变(traumatic optic neuropathy,TON)的疗效。方法回顾性分析陆军军医大学大坪医院2014年11月—2016年12月收治的19例TON患者的临床资料,均为男性,年龄10~63岁,平均30岁。术前视力:无光感7例,光感4例,手动5例,数指3例。所有患者术前甲强龙500mg冲击治疗视力无改善,采用鼻内镜经蝶窦入路的视神经管减压术,根据术前CT测量视神经管长度确定减压范围。随访6个月,观察患者视力恢复情况并分析治疗效果。结果 19例患者中术后视力提高11例,有效率57.9%;7例无光感患者中2例视力有提高,手术有效率28.6%;12例光感以上患者中有9例视力提高,有效率75%,其中最好视力达0.12。术后1例出现脑脊液漏,非手术治疗1周后痊愈;无鼻出血、副鼻窦炎发生。19例随访半年视力无明显改变。结论鼻内镜下经蝶窦入路视神经管减压术是一种安全有效的手术方式,具有创伤小、并发症少等优点,可成为TON手术治疗方式的选择之一。     

大剂量甲泼尼龙治疗急性视神经炎疗效观察

1995～1996年,我们采用大剂量甲泼尼龙治疗急性视神经炎,并与常规用地塞米松治疗法进行对照。结果表明,大剂量甲泼尼龙治疗组疗效优于地塞米松对照组。1　对象和方法1.1　对象　均按文献〔1〕标准确诊。急性视神经炎62例,随机分为两组:(1)治疗组33例65眼。男25例,女8例;年龄21～37岁,平均29岁。发病时间:3～13d,平均8d。视力:指数30cm至0.15。双眼视神经乳头炎11例,单眼5例;双眼球后视神经炎17例,单眼4例;(2)对照组29例43眼,男12例,女17例;年龄17～51岁,平均34岁。发病时间:2～11d,平均6.5d。视力:指数20cm至0.2。双眼视神经乳头炎6例,单眼1…     

大剂量甲泼尼龙治疗视神经脊髓炎临床观察

视神经脊髓炎(neuromyelitis optica,NMO)又称Devic病或Devic综合征,主要特点是合并有视神经与脊髓的脱髓鞘性病变,以往应用常规剂量皮质类固醇治疗,疗效大多不满意,常遗有失明、肢体瘫痪甚至死亡,近年来我们对12例较重的视神经脊髓炎患者进行了甲泼尼龙冲击疗法(methylprednisolone pluse therapy,MPPT),效果较好,现报告如下.     

视神经减压术治疗创伤性视神经损伤的手术时机(国内文献分析)

目的总结不同手术时机对视神经管减压术疗效的影响。方法以关键词"创伤性、视神经损伤、手术时机"检索三大中文数据库,严格按照诊断标准筛查病例,最后收录了16篇国内关于视神经管减压术治疗外伤性视神经损伤的文献报道,通过目前公认的视神经损伤恢复标准判定方法:"无光感、光感、眼前手动、眼前指数、视力表0.04以上",术后与术前视力相比提高1个等级视为有效,分析了这16篇(共670例683眼)文章,讨论选择不同时机行视神经管减压术病例的术后疗效。结果670例683眼中外伤后3d以内手术组,手术有效率77.3%;3～7d手术组,手术有效率65.8%;>7d手术组,手术有效率30%,三组之间相比有统计学意义(P<0.01)。结论外伤性视神经损伤在明确诊断下,如有手术指征并且病人全身条件允许,越早行视神经减压术效果越好。外伤后3d以内手术效果最佳。     

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     

视神经管骨折HRCT检查的临床意义

目的：探讨HRCT检查对视神经管骨折的临床意义。方法：对外伤性视神经伤患者12例行视神经管HRCT扫描,骨算法重建,对骨折的CT表现进行分析。结果：12例患者共14只眼视神经管骨折,视神经管内壁骨折8例,其中内壁为蝶窦壁6例、筛窦壁2例。外壁骨折3例,视柱骨折1便,上壁骨折3例,下壁骨折5例。视神经管骨折CT表现可分为4型：（1）线形型骨折;（2）凹陷型骨折;（3）粉碎型骨折;（4）混合型骨折。14只眼视神经管骨折中9只眼视神经管骨折是颅底骨折的一部分。结论：HRCT检查可提高视神经管骨折的诊断水平,为临床选择治疗方案提供影像依据,具有重要临床意义。     

额-眶-蝶骨纤维结构不良的经颅视神经减压术

为探讨因额 眶 蝶骨纤维结构不良致视力进行性下降经颅做视神经减压术的临床效果 ,作者对收治的 2 5例次患者进行了回顾性研究。结果显示 ,术后 1周 ,2 1例次患侧眼视力改善和稳定 ,4例次视力减退。视力减退的 4例次中有 3例次患侧眼术前视力接近失明。18例次获得有效随访 ,随访时间 2～2 2年 ,平均 6年 ,视力再减退的仅 3例次。研究结果表明 ,经颅做视神经减压术挽救视力是额 眶 蝶骨纤维结构不良致视力进行性下降的有效的手术治疗方法 ,但术前视力接近失明的患者手术效果不理想     

Detection of optic nerve atrophy following a single episode of unilateral optic neuritis by MRI using a fat-saturated short-echo fast FLAIR sequence

We describe an MRI technique for quantifying optic nerve atrophy resulting from a single episode of unilateral optic neuritis. We imaged 17 patients, with a median time since onset of optic neuritis of 21 months (range 3-81 months), using a coronal-oblique fat-saturated short-echo fast fluid-attenuated inversion-recovery (sTE fFLAIR) sequence. The mean cross-sectional area of the intraorbital portion of the optic nerves was calculated by a blinded observer from five consecutive 3 mm slices from the orbital apex forwards using a semiautomated contouring technique and compared with data from 16 controls. The mean optic nerve area was 11.2 mm2 in the affected eye of the patients, 12.9 mm2 in the contralateral eye (P = 0.006 compared to the affected eye) and 12.8 mm2 in controls (P = 0.03 compared to the affected eyes). There was a significant negative correlation between disease duration and the size of the affected optic nerve (r = -0.59, P = 0.012). The measurement coefficient of variation was 4.8%. The sTE fFLAIR sequence enables measurement of optic nerve area with sufficient reproducibility to show optic nerve atrophy following a single episode of unilateral optic neuritis. The correlation of increasing optic nerve atrophy with disease duration would be consistent with ongoing axonal loss in a persistently demyelinated lesion, or Wallerian degeneration following axonal damage during the acute inflammatory phase.     

Detection of optic nerve lesions in optic neuritis using frequency-selective fat-saturation sequences

Summary MRI was performed on seven patients with acute optic neuritis, using two sequences which suppress the signal from orbital fat: frequency-selective fat-saturation and inversion recovery with a short inversion time. Lesions were seen on both sequences in all the symptomatic optic nerves studied.     

The optic nerve sheath on MRI in acute optic neuritis

Optic nerve sheath dilatation or gadolinium-enhancement on magnetic resonance imaging in acute optic neuritis have been previously reported but have been thought to be rare occurrences. This study recruited 33 patients with acute unilateral optic neuritis. All had their optic nerves imaged with fat-saturated fast spin-echo (FSE) imaging, and 28 had imaging before and after triple-dose gadolinium-enhanced fat-saturated T₁-weighted imaging. Follow-up imaging was performed on 20 patients (15 following gadolinium). A dilated subarachnoid space at the anterior end of the symptomatic optic nerve on FSE imaging was seen in 15/33 cases. In three of these cases, dilatation was visible on short-term follow-up. Optic nerve sheath enhancement was seen in 21/28 cases acutely: seven at the anterior end of the lesion only, five at the posterior end only and nine at both ends. Optic sheath enhancement was seen in 13 patients on follow-up. This study suggests that optic nerve sheath dilatation on FSE images and optic nerve sheath enhancement on triple-dose gadolinium-enhanced images are common findings in acute optic neuritis. Optic nerve sheath dilatation may be due to inflammation of the optic nerve, with its associated swelling, interrupting the communication between the subarachnoid space of the diseased optic nerve and the chiasmal cistern. Optic nerve sheath enhancement suggests that meningeal inflammation occurs in optic neuritis, in agreement with pathological studies of both optic neuritis and multiple sclerosis.     

Glioblastoma in the optic chiasm: A case report

Malignant optic gliomas are an uncommon pathology, with around 67 cases reported worldwide in the literature. We present the case of a 77-year-old-male with a two-month history of progressive vision loss, ultimately leading to bilateral blindness. The initial clinical suspicion was a non-inflammatory ischemic optic neuropathy. Stereotactic biopsy was performed on the optic chiasm, and the histopathological diagnosis was confirmed as Glioblastoma.     

视交叉外压性病变引起视力障碍的MRI表现

目的：探讨ＭＲＩ诊断视交叉外压性病变引起视力障碍的临床价值。方法：回顾性分析４４例临床表现双侧视力障碍的ＭＲＩ资料。ＭＲＩ包括横断面，结果：鞍内，鞍上肿瘤３３例，包括垂体瘤１９例，蝶胺外肿瘤１４例；脑积水１１例；ＭＲＩ显示视交叉受压移位及变性，ＭＲＩ显示视交叉Ｔ２加权像上呈不均匀高信号，增强后扫描有异常强化。     

大鼠视神经损伤一氧化氮合酶的分布及其意义

目的观察视神经损伤前后一氧化氮合酶（NOS）的分布,探讨一氧化氮（NO）在视神经损伤中的变化。方法采用大鼠球后视神经横断伤及钳夹伤模型,利用组化NADPH-黄递酶法,于术后1、3、7、14天检测视神经NOS的分布。结果NOS正常情况分布于视神经鞘膜、神经胶质细胞、血管内皮细胞,损伤后神经胶质细胞NOS活性增加,同时局部浸润的炎性细胞也表现出NOS活性。结论视神经损伤NOS的活性增高,提示NO在视神经损伤的病理生理过程中起一定的作用,可能介导了视神经损伤的继发性损害。     

Chiasmatic glioblastoma of childhood. A case report

A 6-year-old girl presented with visual deterioration that had progressively worsened over 2 months. MR imaging revealed a sellar, para- and suprasellar lesion. Subtotal tumor resection was performed. Histopathological diagnosis was glioblastoma of the optic chiasma. Chiasmatic glioblastoma is rare in adults and extremely uncommon in children. Surgical resection implies a risk of severe endocrinologic and opthalmologic complications.     

视交叉病变的MRI分析

目的 分析视交叉病变的MRI表现，探讨MRI对视交叉病变的诊断价值。方法 回顾性分析经临床或病理证实的117例视交叉病变的MRI表现。男54例，女63例，年龄9个月至67岁，平均37．4岁。117例均行MR扫描，101例同时行增强扫描。结果 直接累及视交叉的病变24例，占20．5％。其中胶质瘤11例，表现为视交叉增粗或肿块，伴有视神经或(和)视束受累；炎性病变5例，表现为视交叉弥漫性增粗伴周围结构异常强化，特别是脑膜的炎症；转移瘤5例，其中4例表现为球内肿块沿视神经向球后及颅内侵犯累及视交叉，1例表现为视交叉边缘线状强化伴广泛脑膜强化；脑膜瘤1例，表现为视交叉局限性强化伴视神经肿块；外伤1例，表现为视交叉形态异常伴额叶软化灶；出血1例，表现为视交叉不规则增粗，呈短T1、长T2信号。引起视交叉移位的病变93例，占79．5％，其中视交叉向上移位51例，向前移位2例，向下移位10例，向后移位1例。视交叉一侧受压13例，视交叉显示不清16例。结论 MRI能清晰地显示视交叉病变的特点，对临床诊断与治疗有重要价值。     

A kindred of hereditary adult-onset leukodystrophy with sparing of the optic radiations

We describe a family with hereditary adultonset leukodystrophy with sparing of the optic radiations, shown clinically, neuroradiologically and electrophysiologically. All five affected members developed their leukodystrophy in their fourth decade and clinical features steadily progressed. The sparing of the optic radiations is not typical of other leukodystrophies. We suggest that this is a new clinical entity.