手术治疗急性脑外伤合并视神经损伤的疗效分析

目的探讨急性颅脑外伤合并视神经损伤的有效治疗方法。方法手术治疗29例颅脑损伤合并视经损伤患者,15例行额部冠状切开减压,12例行额颞部开颅清除眶骨骨折片或血肿,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,切开视神经鞘进行神经减压。2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25例有效,其中1例眼球突出、3例眼球内陷均得到矫正,总有效率86郾2%。结论眶部CT检查对管内段视神经损伤具有重要诊断价值,CT检查阴性不能除外该病;疗效与视神经损伤程度和手术时机等因素有关;经额部或额颞入路手术行视神经减压,结合术后高压氧治疗对颅脑损伤合并视神经损伤的患者可取得良好效果。     

显微减压术治疗外伤性视神经损伤

目的 介绍一种显微镜视神经减压手术的新入路，并对此入路的优点和特点进行探讨。方法 对外伤性的视神经损伤采用经翼点入路显微视神经减压术治疗23例。结果 23例中，有14例术后视力有不同程度恢复，8例术后视力未恢复，1例术后视力恶化。结论 经翼点入路更便于显微视神经减压术的手术操作。其手术疗效除了与手术入路有关外，还与显微手术技巧、手术时机及视神经损伤的性质和程度有关。     

颅脑损伤并发球后视路损伤的手术治疗

作者于近年来收治１５例颅脑损伤并发视力障碍的患者，均经手术治疗。１３例行双额部冠状切开头皮，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，剪开神经鞘进行视神经减压。２例视力障碍伴有眶上裂综合征者行额颞切口，经眶尖外侧壁磨开骨折眶上裂和视神经管，行神经减压。结果：１０例（６５．９％）有效，３例突眼和１例眼球陷入患者均得到矫正。结论：经额颞入路手术减压可对颅脑损伤并发视力障碍取得良好效果。     

经颅硬膜外入路双层壁视神经管减压术的研究

目的 探讨经颅硬膜外入路治疗双层壁视神经管视神经损伤中的手术方法及效果.方法 选择6例经CT证实双层壁视神经管的视神经损伤患者,经颅硬膜外入路,切除气化筛窦构成的眶上壁至视神经管眶口,显微镜下切除气化的视神经管上壁,切断筛后动脉,自额筛缝之前咬除眶尖骨质及视神经管上壁、内侧壁和外侧壁,减压周径大于1/2而小于3/4,未剪开视神经鞘,封闭蝶窦及后组筛窦的漏口.结果 6例患者均有效,其中3例视力达0.1及以上,无脑脊液漏,颅内感染.结论 经颅硬膜外入路双层壁视神经管减压术是针对视神经管变异为双层时的有效治疗,具有减压范围充分的特点.视神经损伤患者为双层壁视神经管时应积极手术治疗.     

经颅显微减压术治疗创伤性视神经损伤

目的探讨经颅入路视神经减压术的手术方法和显微手术技巧,以提高创伤性视神经损伤的手术疗效。方法行减压术治疗创伤性视神经损伤36例,取冠状切口骨瓣开颅（或翼点）入路,在手术显微镜直视下手术,切开颅底硬脑膜,暴露及开放视神经管上壁和外侧壁,显露视神经不少于1/2周径,剪开视神经鞘膜和总腱环。结果本组均术后随访3月以上,28例视力明显提高,7例术后视力未恢复,1例术后视力恶化,无术后并发症。结论适宜的手术时机、合理的手术入路、充分的术中减压和精细的显微外科技巧可显著提高创伤性视神经损伤的手术疗效。     

外伤性难治性癫痫手术治疗15例报告

外伤性癫痫是颅脑损伤最严重的并发症之一 ,重型颅脑损伤癫痫的发生率高达 3 0 % ,而其中相当一部分是药物无法控制的 ,需手术治疗。我院自 1996年 2月～ 1998年 3月对 15例外伤性难治性癫痫进行手术治疗 ,效果良好 ,现报告如下。临床资料一、一般资料 :男性 11例 ,女性 4例 ,年龄 8～ 42岁 ,病程4～ 13年 ,其中 13例有重型颅脑损伤开颅术史。伤情类型 :3例系开放性颅脑损伤行脑清创术 ,8例额颞部脑挫裂伤伴血肿行开颅、血肿清除、去骨瓣减压术 ,2例因额顶部凹陷性骨折行碎骨片摘除术 ,另外 2例非开颅患者因额颞部挫裂伤行保守治疗。发作类…     

经颅入路视神经减压术治疗视神经损伤11例

目的 评价经颅入路视神经减压手术方法及临床效果。方法 作冠状切口骨瓣开颅（或翼点）入路，在手术显微镜直视下切开颅底硬脑膜，暴露并开放视神经管上壁和外侧壁，显露视神经不少于1/2周径，剪开视神经鞘膜和总腱环。结果 临床施行减压术11例，术后8例视力提高，无并发症性。结论 经颅入路视神经减压术，操作方便，减压充分，安全可靠，疗效肯定。     

颅脑外伤并视神经损伤33例临床分析

目的 :评价视神经管减压术治疗视神经损伤的疗效。方法 :3 3例视神经损伤患者 ,8例行经颅视神经管减压术 ,6例行经眶 -筛窦 -蝶窦视神经管减压术 ,19例单纯药物治疗。结果 :3 3例患者中视力提高者 16例 ,有效率 48.48%(16/3 3 ) ,手术组 14例中视力提高者 9例 ,有效率 64 .2 9% (9/2 4) ;药物组 19例中视力提高者 7例 ,有效率 3 6.84% (7/19)。结论 :对严重的视神经损伤患者应尽早行视神经管减压术     

经翼点入路显微视神经管减压术治疗外伤性视神经损伤

目的评价经翼点入路视神经减压的手术方法和临床效果。方法12例视神经受压损伤患者,经翼点开颅,显露并开放视神经管全长,剪开神经鞘膜和总腱环。结果本组12例术后10例视力有提高,2例视力无改善。结论经翼点入路视神经减压术视野好,操作方便,减压充分,安全有效。     

延迟行经鼻内镜视神经管减压术治疗外伤性视神经病变疗效分析

目的 探讨延误最佳手术治疗时机后才行经鼻内镜视神经管减压术治疗外伤性视神经病变(TON)的临床结局. 方法 回顾分析8例平均外伤43天(12～128天)后才行经鼻内镜视神经管减压术的TON患者的临床特征及治疗效果. 结果 随访1～12个月,总体手术疗效87.5％ (7/8),其中具有实用价值视力(≥0.02)的比例62.5％(5/8).3例伤后无光感的患者,2例有效,但均术获得实用价值视力.经手术治疗后,视力从术前(2.5±2.1)提高到(3.4±1.9),平均提高(0.9±0.9),差异有统计学意义(t=2.70,P＜0.05). 结论 经鼻内镜视神经管减压术治疗TON安全、有效.对于残存部分视力的TON患者,即使伤后数周,仍建议行视神经管减压术,可望恢复部分视力或扩大视野；对于无光感的TON患者,可能难以获得实用价值视力,应视患者需求谨慎施行视神经管减压术.     

Endoscopic decompression of the optic canal for traumatic optic neuropathy

Purpose: Traumatic optic neuropathy (TON) is a serious complication of head trauma with the incidence rate of 0.5%e5%. The aim of this study was to investigate the therapeutic efficacy of endoscopic decompression of the optic canal for optic nerve injuries. Methods: In this study, 11 patients treated in our hospital from January 2009 to January 2015 with the visual loss resulting from TON were retrospectively reviewed for preoperative vision, visual evoked potential (VEP) scan, surgical approach, postoperative visual acuity, complications, and follow-up results. Results: All these patients received endoscopic decompression of the optic canal. At the 3-month followup, the visual acuity improvement rate of the 11 patients was 45.5%. The vision acuity of 2 cases improved from hand movement to 0.08 and 0.3 after operation. Another patient''s vision acuity returned to 0.05 compared to light sensation preoperatively. Two cases had finger counting before surgery but they had a vision acuity of 0.4 and light sensation respectively after surgery. However, the other 6 cases'' vision did not improve after surgery. Conclusion: Endoscopic decompression of the optic canal is an effective way to cure TON. VEP could be used as an important reference for preoperative and prognosis evaluation. Operative time after trauma is only a relative condition that may affect the therapeutic effect of optic canal decompression. Poor results of this procedure may be related to the severity of the optic nerve injury.     

双层壁视神经管视神经损伤的诊断与治疗

目的 探讨双层壁视神经管时视神经损伤的临床诊断与治疗的特点.方法 回顾性分析自2005年1月～2006年12月经CT证实双层壁视神经管的6例视神经损伤患者,经药物、手术及视力康复训练的临床资料,分析CT、视觉诱发电位、视力恢复情况.结果 6例患者中4例为完全双层壁视神经管,2例为部分双层壁视神经管,其中4例见视神经管骨折;6例患者视力均好转,且3例视力达到0.1.结论 患者为双层壁视神经管时,视神经损伤程度轻,经药物、手术及视力康复训练后,视力恢复较好.     

外伤性视神经病变的疗效分析

目的探讨外伤性视神经病变的治疗方法和效果。方法52例57眼中,44例(48眼)给予药物治疗;9例(9眼)接受经颅视神经减压术,同时给予药物治疗。并将两组疗效对比分析。结果药物治疗48眼,有效16眼,无效32眼,有效率占33.33%;手术治疗9眼,有效4眼,无效5眼,有效率占44.44%。药物治疗和手术治疗比较差异无统计学意义(P=0.795)。结论外伤性视神经病变视力损伤重,治疗效果差,尚无有效的治疗方法。     

Transethmoidal decompression of the optic nerve in the case of craniocerebral trauma

Over a period of ten years, 39 patients who had suffered optic nerve compression after a craniocerebral trauma underwent transethmoidal decompression surgery. The operation was performed bilaterally on 5 patients. Fifty percent of patients involved suffered a blunt head or brain injury, the others brain compression or contusion. On the side of optic nerve compression, we found specific signs and symptoms of the compression such as negative or sluggish direct light reaction of the pupil, wounds on the lateral side of the eyebrow, bleeding from the nose, eyelid hematoma, skull fractures and intracranial hematomas. Since radiological and intraoperative findings were the same in only 67% of cases ophthalmological findings such as lack of direct pupil reaction occurring together with preserved consensual light reaction and progressive loss of vision after a traumatic incident are used as guideline for performing transethmoidal decompression of the optic nerve. Surgery produced restitution of visual function in about 10% more cases than conservative therapy reported in the literature.     

Surgical treatment of progressive visual loss in traumatic optic neuropathy. Report of two cases

In two patients with traumatic optic neuropathy progressive visual loss was reversed by surgical decompression of the optic nerve sheath. The first patient with hemorrhage beneath the optic nerve sheath had progressive loss of vision from counting fingers to no light perception within 24 hours after the injury. Surgical evacuation of the hematoma improved visual acuity to 8/30. The second patient had progressive visual loss from 20/20 to 20/400 within the 1st week after injury. Drainage of an arachnoid cyst of the optic nerve sheath improved visual acuity to 20/25. Computerized axial tomography disclosed the hemorrhage in the first case and enlargement of the optic nerve sheath in the second. While the management of traumatic optic neuropathy is controversial, surgical intervention for an arachnoid cyst and hematoma involving the optic nerve is clearly beneficial.     

Unusual optic nerve compression by a flap of dura mater

Following a head injury, a 16-year-old boy suffered from visual impairment due to compression of the optic nerve by a dural flap peeled from the planum sphenoidale. After surgical decompression, visual acuity was improved. Posttraumatic visual disturbance is not uncommon; but cases such as ours appear to be rare. In this report, the possible causative mechanisms and the operative indications of posttraumatic visual disturbance are discussed.     

Outcome of Traumatic Optic Neuropathy. Comparison Between Surgical and Nonsurgical Treatment

Summary  34 patients with indirect traumatic optic neuropathy were studied to identify factors affecting outcome and surgical indications. 12 cases (13 eyes = group A) underwent surgery and 24 patients (24 eyes = group B) were managed without surgery. Age, optic canal fracture, visual acuity before treatment (initial visual acuity) and days until surgery (only group A) were employed as variables. Visual acuity improved significantly more in patients with initial visual acuity, hand movement (HM) or better than in those with initial visual acuity for light perception (LP) only or worse. When initial visual acuity was HM or better, vision improved significantly more in patients with surgery than in those without surgery (p=0.0003) by Mann-Whitney U test). Days until surgery were correlated with visual improvement in patients with visual acuity HM or better. Age and optic canal fracture did not affect visual improvement or influence the decision for or against surgery.