视神经减压术治疗外伤性视神经病变

目的 评价视神经减压术治疗外伤性视神经病变的效果.方法 回顾性分析24例(24眼)外伤性视神经病变的临床资料.术前视力:无光感14眼,光感8眼,数指2眼,所有患者术前均经糖皮质激素冲击治疗无效.对其中14例行经眶筛进路视神经减压术,10例行鼻内镜下视神经减压术.手术距外伤时间:3～23 d.术后观察视力,随访2 ～ 24个月.结果 24例中17例有效,总有效率70.8％.其中7例达0.05 ～0.8,显效率29.1％.术前有残余视力(光感～数指)者10例均有效,有效率100％,其中6例术后达显效,占60％.无光感14例中,7例有效,有效率50％,其中6例术后恢复残余视力,1例术后1年达0.2.伤后3～7d无光感行手术减压者10例中有6例达到光感以上视力,有效率60％,伤后无光感8～23 d手术者4例中仅有1例达光感,有效率25％.结论 对外伤性视神经病变糖皮质激素冲击治疗无效的病例,手术减压是安全有效的.术前有残余视力者保守治疗无效应积极手术.无光感者一旦确定手术应在1周内尽早实施.     

鼻内镜下视神经管减压术治疗外伤性视神经损伤的疗效观察

目的 探讨鼻内镜下视神经管减压术治疗管段视神经损伤的可行性及疗效.方法 鼻内镜下经鼻腔筛、蝶窦行视神经管减压术治疗视神经外伤8例(8眼),其中30～60 cm指数2眼,眼前手动1眼,光感1眼,无光感4眼.结果 术后随访4～32个月,术前有残余视力的4例患者术后视力分别改善到0.1,0.2,50cm,30 cm指数,术前视力无光感的4例患者术后1例有光感,无一例发生严重并发症.结论 鼻内镜下行视神经管减压术治疗外伤性视神经损伤创伤小,面部无切口瘢痕,患者易接受.(中国眼耳鼻喉科杂志,2007,7377-378)     

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.     

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。     

视神经管减压术治疗间接性视神经挫伤30例

目的评价视神经管减压术治疗视神经挫伤的疗效和影响疗效的因素。方法手术治疗限定于外伤后1月内,并且无严重颅脑损伤、无严重全身病患者。手术方式采用经眶—筛窦—蝶窦视神经管减压术,全麻或局麻下施行。术前、术后常规应用大剂量糖皮质激素和神经营养药物治疗。结果30例患者中19例术后视力有不同程度提高,有效率为63%(19/30),24例术前无光感者,13例术后1周以后恢复光感以上的视力,有效率为54%(13/24),6例术前有光感～0.04,术后视力提高显著,有效率100%。手术病程15d以内者优于15d以上者。结论对严重的视神经挫伤患者应尽早行视神经管减压术,手术的效果与患者手术前的视力状况及病程的长短有关,术前、术后大剂量糖皮质激素及神经营养药物的应用对提高有效率也尤为必要。     

鼻内和眶内进路视神经管减压术临床对比观察

目的探讨和比较鼻内和鼻外两种进路视神经管减压术临床疗效。方法视神经外伤32例（32眼）。采用经鼻外眶内侧进路筛蝶窦视神经管减压术20例,经鼻内镜鼻内筛蝶窦进路视神经管减压术12例。结果眶内组20例中有12例（60％）术后视力有不同程度提高,分别从术前的无光感提高到术后的0．06,光感到0．08～0．15,手动到0．12～0．15,数指到0．2,0．02到0．2,0．03到0．15。鼻内组12例中有9例（75％）术后视力有明显提高,分别从术前的无光感到术后的0．25,光感到0．2～0．25,手动到0．2—0．3,0．02到0．3。按Wileoxon统计法,P〈0．05。结论本组鼻内进路视神经管减压术临床效果优于眶内进路,认为鼻内窥镜下视神经管减压术有较好疗效。     

影响外伤性视神经病变疗效的临床因素分析

目的评价手术疗法和非手术疗法治疗外伤性视神经病变的疗效和影响疗效的临床因素。方法回顾分析40例外伤性视神经病变患 者41只眼分别行以鼻内窥镜下视神经管减压术为主的手术治疗(28例)和以药物治疗为主的非手术疗法治疗(12例)后的视力恢复情况。结果治疗前有光感～ 0.02视力者手术治疗组与非手术疗法治疗组的疗效差别不显著;手术治疗组术前有光感 ～0.02视力者疗效显著优于术前无光感者;手术前病程7 d以内者疗效优于病程7 d以上 者。结论对于严重的外伤性视神经压迫病变应尽早手术。手术前有无视力及病程长短是影响手术效果的重要因素,在受伤后7 d内越早手术治疗效果越好 。(中华眼底病杂志,2001,17:204-206)     

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。     

鼻内窥镜下经蝶窦视神经管减压术疗效观察

目的：观察鼻内窥镜下视神经减压术的手术及临床效果。方法：对8例因外伤致视神经损伤的病例，在全麻下行鼻内窥镜视神经减压术，并对术中所见、手术时间及术后视力恢复情况进行临床分析。结果：8例患者均由该术式视神经减压获得成功；原发视神经损伤3例，术后视力无改善；继发视神经损伤5例，术后视力有明显的恢复，视力分别从术前的无光感、光感、手动／眼前、手动／眼前、0．04提高到术后的0．1、0．08、0．06、0．1、0．1。结论：视神经损伤一旦确定，应尽早手术，本术式对筛、蝶窦骨折累及视神经、继发视神经损伤及视神经管内壁骨折者为较好选择；伤后有光感或视力渐进下降者，手术效果较好，对伤后无光感的患者，应认真分析损伤情况，对有视功能改善可能者，亦可尽早实施手术；手术时间尽早为好，但伤后时间较长者，亦不能放弃争取视功能改善的机会。     

外伤性视神经病变28例疗效分析

目的 :探讨外伤性视神经病变的诊断和治疗效果。方法 :外伤性视神经病变 2 8例 2 8眼分A组 (经眶筛进路视神经减压术 7例 )、B组 (大剂量皮质激素 灯盏细辛注射液 11例 )、C组 (皮质激素 一般药物 10例 ) 3种方法进行对比治疗。结果 :2 8例最终有效率为 78 5 7% ,显效率 64 2 9% ,无效 2 1 43 %。有效率A组 (85 71% ) ,B组 (90 91% ) ,C组 (60 % )间差异无显著性意义。 3天内开始治疗组与 15天以上治疗组有效率比较 0 0 1

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Surgical decompression in traumatic optic neuropathy

BACKGROUND: The management of traumatic optic neuropathy remains controversial. This retrospective study presents the results of 19 cases of indirect optic neuropathy where surgical decompression represented the primary mode of treatment. METHODS: Nineteen patients (20 optic nerves) with traumatic optic neuropathy underwent primary surgical decompression. The surgery was performed using the transethmoidal technique. RESULTS: The extent of bony optic canal injury documented during surgery indicated that this had been underestimated in this series by CT findings. Vision improved in eight patients, five of whom had had no light perception preoperatively. CONCLUSION: Primary surgical decompression of the optic nerve within 48 h of injury produces beneficial results. Testing of visual acuity 6 weeks after surgery does not serve as a reliable predictor of final outcome.     

视神经损伤鼻内窥镜下视神经管减压术

目的 分析间接性视神经损伤的特点以及鼻内窥镜下视神经管减压术的手术方法。方法 介绍1998－1999年我院施行鼻内窥镜下视神经管减压术6例（6眼），比较手术前后的视力、瞳孔变化。结果 6例术后均维持和提高视力，肯定鼻内窥镜下视神经管减压术能改善间接损伤的视神经功能。结论 鼻内窥镜下视神经管减压术优于其他手术进路的视神经管减压术，避免诸多并发症及其危险。     

微创鼻内镜下视神经减压术在外伤性视神经病患者中的应用

目的 分析鼻内镜下视神经减压术在外伤性视神经病患者中的应用效果.方法 选取2014年1月至2016年1月我院收治的外伤性视神经病患者100例(100眼)为观察对象,按治疗方法不同分为观察组与对照组,每组各50例.对照组采取药物治疗模式,观察组在对照组的基础上,待病情稳定后采取鼻内镜下视神经减压术治疗.术后至少随访1 a,对比两组患者的临床疗效、视力、视觉诱发电位检查结果、不良反应发生率等.结果 观察组与对照组的治疗有效率分别为76.0％和36.0％,两组相比差异有统计学意义(P＜0.05).观察组22眼无光感者中16眼视力提高,13眼光感者中9眼视力提高,11眼眼前手动者中9眼视力提高,4眼眼前数指者视力全部提高;对照组20眼无光感者中6眼视力提高,14眼光感者中6眼视力提高,12眼眼前手动者中5眼视力提高,4眼眼前数指者中1眼视力提高.治疗后,观察组P100潜伏期为(116.85±7.96) ms,P100振幅为(5.11±1.16)μV,均优于对照组的(105.62±6.82) ms、(4.31±1.25) μV.观察组不良反应发生率显著低于对照组(P =0.000).结论 鼻内镜下视神经减压术在外伤性视神经病患者中具有较好的应用效果和安全性,能够有效改善患者的视力,有助于提升患者的生活质量,值得在临床中推广使用.     

Optic Neuropathy with Delayed Onset After Trauma: Case Report and Review of the Literature

The authors report a case of a 16-year-old healthy male who experienced loss of vision in the right eye immediately after getting punched by a fist. His visual acuity improved to 20/20 within hours, and the optic nerve head appeared normal. Computed tomography (CT) scan of the orbits showed fractures of the right inferior orbital wall and lamina papyracea. The morning after the injury, he awoke with right eye vision decline to count fingers. There was pallid optic nerve swelling. Magnetic resonance imaging (MRI) scan of the orbits showed right medial rectus enlargement and no optic canal abnormalities. The patient was treated with intravenous (IV) methylprednisolone with improvement in visual acuity. Literature of delayed traumatic optic neuropathy (TON) and anterior TON is reviewed.     

Traumatic optic neuropathy in children and adolescents.

PURPOSE: Retrospective review to describe the features and visual outcome of traumatic optic neuropathy (TON) in children and adolescents. METHODS: Interventional and observational case series of children <18 years with TON. RESULTS: Forty children, 24 boys and 16 girls, were identified with 43 affected eyes. The mean age was 11.6 years (range, 2 to 18). The most common causes were motor vehicle accidents (62%) and sports injuries (22%). The trauma was blunt in 78% of cases and penetrating in 22%. Visual acuity at presentation for 27 patients whose visual acuity could be assessed ranged from no light perception to 20/80. Interventions included corticosteroids (n = 18), decompression of the optic canal (n = 3), and optic sheath nerve fenestration (n = 1). Visual outcome for 22 children with at least 1 month of follow-up was no light perception in 10 (45%), < 20/200 in 7(32%), 20/200 to < 20/80 in 1(4%), and > or = 20/80 in 4 (18%). There was no difference in the rate or degree of improvement between treated and untreated patients. CONCLUSION: TON in children is caused by mechanisms similar to those that cause TON in adults. The severity of visual loss as well as the rate and degree of improvement are also similar. Our data do not indicate that treatment improves visual outcome.     

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.