鼻外筛窦进路视神经减压术（附3例报告）

报告经鼻外筛窦进路视神经减压术治疗视神经管内损伤３例，因就诊时间较晚，２例无改善，仅１例视力好转。手术体会：①应尽早在伤后１周内进行减压术；②显微镜下手术，保证良好的暴露与减压；③术者应熟悉视神经解剖与定位标志；④视神经骨管内壁减压范围超过管径的１／２，长度约５ｍｍ，可获减压效果，如无明显神经肿胀或淤血，不需切开神经鞘膜。     

蝶筛窦黏液囊肿引起视力下降1例并文献复习

<正>有视力损害等眼部症状的蝶筛窦黏液囊肿临床上并不少见,胡鹏等[1]曾对23例伴视力减退的鼻窦囊肿进行分析,其中累及蝶窦或蝶筛窦7例,由于大多数患者首诊于眼科,如果缺乏对鼻窦疾病的认识,易被误诊为单纯的眼科疾病,错过手术治疗的最佳时机,影响患者视力的恢复[2]。此类疾病一旦确诊,应尽早行鼻内镜手术清除病灶,必要时行视神经管减压术以改善症状,恢复视力。2014年1月25日我们收治蝶筛窦黏液囊肿引起视力下降1例,报     

鼻内镜在视神经管减压中的应用

目的：探讨鼻内镜在视神经管减压中应用的可能性。方法：18例视神经管损伤病人进行经鼻视神经管减压术。结果：18例病例中12例患者视力较前有提高。分别从术前的无光感，眼前手动，50cm指数，眼前手动，无光感、光感，无光感，眼前手动、无光感，光感、光感，无光感到术后视力恢复为0.2,0.3,0.3,0.4,0.06,0.3,0.1,0.7,0.12,0.4,0.1,0.03。结论：经鼻内镜视神经管减压术损伤小，并发症少，手术时间短，为治疗视神经损伤的较好方法。     

视神经管减压术治疗视力损伤

目的研究视神经减压术治疗视神经管骨折所导致视力损伤的疗效.方法对20例视神经管骨折导致视力减退或丧失者,采用鼻侧切开经筛窦视神经减压术.结果术后视力恢复至0.01以上6例;恢复至有光感或手动8例,无效6例.总有效率为70%.结论采取减压手术越早,视神经恢复越好.即使术前无光感或伤后不超过15d,也不应放弃手术治疗.     

视神经减压术在治疗视神经萎缩中的应用

目的：探讨视神经减压术在视神经萎缩治疗中的作用。方法：16例患者经视力、眼底及视觉诱发电位（VEP）检查后确诊为视神经萎缩,均采用经鼻外筛、蝶窦径路视神经减压术,术时去除筛窦,打开蝶窦,找到视神经管,去除其周径的1／2以上,打开视神经管全长,纵行切开视神经鞘膜及总腱环;术后给予抗生素、激素、血管扩张药及神经营养药治疗,对比手术前后的视力、眼底及VEP的变化。结果：16例患者术后视力均有不同程度的提高,VEP均有改善,术后1周及3个月复查眼底,10例有改善,6例无变化。所有患者均无严重的手术并发症。结论：视神经减压术是治疗视神经萎缩的有效方法。     

视神经外伤经筛、蝶窦径路减压术治疗(附35例报告)

为了解经筛，蝶窦径路行视神经减压术对外伤视神经损伤治疗的有效性及手术时机的选择作回顾性研究。对４１你外伤性视神经损伤患者中的３５列行经筛，蝶窦径路减压术，另６例应用大剂量皮质激素保守治疗。结果手术后中１３２例视力得到改善，保守治疗者中１例视力改善。１２例治疗前有残余和的患者，８例接受手术治疗，其中７例视力理以改善；４例接受保守治疗者１，例视保守治疗者，视力均未得到改善。结论：经筛蝶窦径路视神经减压     

鼻内镜下视神经减压术治疗视神经损伤

目的：探讨鼻内镜下视神经减压术治疗视神经损伤的疗效。方法：鼻内镜下自鼻腔经筛蝶窦行视神经管减压术治疗视神经外伤10例。结果：随访6个月～4年，术前视力无光感3例术后视力无改善，有残余视力7例术后视力均有不同程度的提高，无1例发生严重的并发症。结论：鼻内镜下视神经减压术创伤小，面部无切口疤痕，是治疗视神经损伤较好的方法，患者易接受。对有残余视力的患者要尽可能地手术治疗，对无光感者手术应慎重。     

经上颌窦眶减压术治疗恶性突眼症

目的：评价经上颌窦眶减压术治疗恶性突眼的临床适应证和应用价值。方法：对５例９眼患者行经上颌窦眶减压术。结果：术后随访３个月￣２年,突眼度平均下降５ｍｍ;４例眼睑能闭剑,１例睑裂明显缩小;１例单眼突眼术后复视消失,１例双眼突眼先后手术者左眼术后出现复视,右眼术后消失;２例眼球运动障碍者术后均有改善,２例继发性青光眼术后缓解,２例暴露性角膜炎愈合;２例视力下降者术后有提高。结论：经上颌窦眶压术是保护眼     

经上颌窦柯陆氏手术行视神经减压

因交通事故或外伤致头部损伤合并视力损害者约占颅脑外伤2.6％,外伤性视神经管骨折是引起视力损害的一种常见病因,如能早期进行视神经管开放减压术对视力的恢复有所裨益。著者在一年中进行经上颌窦柯陆氏手术视神经管开放减压术7例,介绍如下: 一、手术方法:1.局麻下行柯陆氏手术,上颌窦外壁骨窗的内上角要求开得大而宽,以便     

鼻内镜下视神经管减压术治疗外伤性视力障碍14例报告

目的：探讨视神经管减压术治疗外伤性视力障碍的有效方法。方法：采用鼻内镜下视神经减压术治疗外伤性视力障碍患者14例。结果：随访3-18个月，其中8例有不同程度视力改善，6例无效。术后全部患者术腔上皮化，无并发症发生。结论：经鼻内镜筛蝶窦入路视神经减压术损伤较小，疗效确切，且不遗留面部瘢痕，容易为患者所接受。对伤后数天至1个月、大剂量激素治疗无效、视力损伤严重的患者，手术仍有可能挽救视力。     

The management of acute visual loss after sinus surgery--two cases of rhinogenic optic neuropathy

INTRODUCTION: Different causative mechanisms of ophthalmic complications during endonasal sinus surgery have been reported. Only a few cases of blindness caused by affections of the optic nerve due to inflammatory paranasal sinus disease have been described. OBJECTIVE: Inflammatory optic neuropathy shall be considered among the causative factors for amaurosis after sinus surgery. MATERIAL: We present two patients with dramatic visual decrease occurring two weeks after sinus surgery as a result of inflammatory posterior paranasal sinus disease. RESULTS AND CONCLUSION: Our therapy including surgical intervention in form of orbital or optic nerve decompression accompanied by systemic steroids and antibiotic therapy resulted in a significant increase of visual acuity in one case and a complete restoration of vision in the other case. In these two cases surgical intervention in the described fashion along with systemic steroids and antibiotic therapy represented a successful therapeutical approach.     

Prolonged visual disturbance secondary to isolated sphenoid sinus disease

OBJECTIVES/HYPOTHESIS: The objective was to evaluate the efficacy of endoscopic sinus surgery in patients with isolated sphenoid sinus disease with visual disturbances of more than 72 hours' duration. STUDY DESIGN: Retrospective review. METHODS: A sequential series of patients with isolated sphenoid sinus disease with visual disturbances who underwent endoscopic surgery performed by the same surgeon between 1995 and 2002 were reviewed. Patients with malignant tumors were excluded from the study. Patients were evaluated preoperatively and postoperatively to record the effects of this approach on visual acuity and diplopia. RESULTS: The study population included six women and seven men with a mean age of 56.2 years (age range, 31-75 y). Eight eyes had vision loss attributable to compressive optic neuropathy (27%) and optic neuritis (27%); seven eyes with diplopia had abducens palsy (40%) and oculomotor nerve palsy (7%). Sphenoid sinus lesions included sinusitis (38%), mucocele (31%), and aspergillosis (31%). The mean interval between the onset of visual disturbances and surgery was 6.6 months (range, 3 d-3.5 y). Visual disturbances improved in 60% of the patients (P <.01). There was better improvement in diplopia than in vision loss (P <.01). The results of endoscopic sinus surgery for patients with abducens palsy and aspergillosis were excellent (83% and 80%, respectively). Optic neuritis and visual disturbances lasting for more than 6 months were regarded as poor prognostic factors. CONCLUSION: The study supports the treatment of visual disturbances resulting from isolated sphenoid sinus disease by endoscopic sinus surgery. A timely operation may prevent permanent sequelae.     

鼻内镜下视神经减压术治疗外伤性视力完全丧失的预后相关因素分析

目的探讨鼻内镜下视神经减压术对外伤性视力完全丧失的疗效,并评估其预后相关因素。方法回顾性分析85例外伤性视力完全丧失患者的临床资料,通过单因素分析和Logistic回归分析来评估其潜在的预后相关因素。结果鼻内镜下视神经减压术后,患者总体视力提高44．7％（38J85）。单因素分析显示：筛窦和（或）蝶窦内积血是视力改善的负性因素。而Logistic回归分析显示：外伤到手术的时间超过3d、筛窦和（或）蝶窦内积血与外伤性视力丧失的预后呈负性相关。结论筛窦和（或）蝶窦内积血、外伤到手术的时间超过3d是外伤性视力丧失视力恢复的危险因素。视力完全丧失的患者伤后3d内如能实施手术,视力可能得以较好改善。     

外伤性视神经损伤的临床处理

目的 :观察经鼻外筛蝶窦径路行视神经减压术辅助药物治疗对外伤性视神经损伤的疗效。方法 :14例外伤性视神经损伤患者经鼻外筛蝶窦径路行视神经减压术的同时辅以大剂量激素及神经营养药物治疗。结果 :总有效率为 5 7.14% ,术中、术后无任何严重并发症 ;其中 2例伤后 8、11d手术 ,术后 6个月仍无光感。结论 :鼻外筛蝶窦径路行视神经减压术损伤较小 ,术野暴露充分 ,简易安全 ;同时辅以药物治疗 ,更有利于神经功能恢复。综合性治疗对外伤性失明患者是一种较好的措施。     

鼻内镜下视神经减压术治疗外伤性视神经病72例

目的 探讨视神经减压术治疗外伤性视神经病的疗效。方法 对大剂量糖皮质激素冲击治疗无效的外伤性视神经病患者72例（73眼），采用鼻内镜下视神经减压术治疗。外伤至手术时间1～57d，其中≤3d15例，4—7d37例，8—10d9例，11—15d5例，16～30d5例，〉30d1例。术前视力：光感以上18眼；无光感55眼。结果 术后随访3个月-5年。73眼中46眼视力有不同程度的提高，总有效率63．01％。原无光感的55眼中，31眼视力有提高，有效率56．36％。有光感以上视力的18眼中，15眼视力有提高，有效率83．33％。术后全部患者术腔上皮化，术中无并发症发生。结论 经鼻内镜筛蝶窦入路视神经减压术进路简捷，损伤较小、疗效确切，且不遗留面部瘢痕，容易为患者所接受。对伤后时间较长、大剂量激素治疗无效、视力损伤严重的患者，手术仍有挽救视力的可能。     

鼻内镜鼻窦手术眼部并发症及其处理对策

目的 探讨鼻内镜鼻窦手术的眼部并发症可能的原因及处理经验,以期引起鼻内镜外科医生的重视.方法 收集作者收治的具有比较典型特征的鼻窦手术眼部并发症者22例8类.损伤类型分别为:纸样板损伤、眶内感染、额筛阻塞性囊肿、泪道损伤、眼外肌损伤、眶内出血、视神经损伤、眼底动脉栓塞等,并给予了相应处理.结果 单纯纸样板损伤9例中8例经保守治疗痊愈,眶纸样板损伤伴眶骨膜下感染1例和泪道损伤、额筛阻塞性囊肿各1例经鼻内镜手术痊愈.眼外肌损伤2例中1例经眼肌矫正术后除向健侧有轻微复视外,其他眼位无明显复视;另1例经眼肌矫正后仍有轻度复视.眶纸样板损伤致眶内出血1例痊愈,另1例眶内出血和1例眼底动脉栓塞导致的视力丧失无改善.视神经损伤6例(7侧)中1例(1侧)经视神经减压+眶尖减压视力恢复正常,另1侧及其余5例(5侧)无改善.结论 鼻内镜手术导致视神经损伤、眶内出血和眼底动脉栓塞导致的失明,治疗困难,预后极差;如果有残存视力,预后较好.     

内镜下治疗鼻源性视觉障碍的临床研究

目的 探讨鼻源性视觉障碍性疾病的诊断与治疗模式.方法 回顾性分析23例(25眼)资料完整的鼻眼相关视功能障碍病例,23例均行内镜下鼻腔鼻窦探查+鼻窦开放术,其中9例行视神经管减压术.结果 双侧全组鼻窦炎4例,单侧后组筛窦、蝶窦炎6例,额窦、筛窦炎1例,孤立性蝶窦炎5例,单侧后组筛窦、蝶窦真菌病5例,单侧蝶窦、筛囊肿或脓囊肿2例,均经术后病理证实.术前视功能:2例(2眼)无光感;6例(7眼)眼前手动;7例(7眼)眼前指数(＜ 20 cm);8例(9眼)有不同程度视力下降.1例次(1眼)眼球突出、直接和间接瞳孔对光反射消失;3例次(3眼)复视;2例次(2眼)外展麻痹;3例次(3眼)视野缺损(1眼中央性,2眼颞侧);1例次(1眼)上睑下垂.全部病例术后鼻窦术腔上皮化.术后视功能:2眼无改善;10眼恢复到发病前水平;13眼由术前眼前手动、指数改善到眼前指数(30～60 cm).其他眼部症状消失.结论鼻源性视觉障碍患者出现视力障碍时,若药物保守治疗无效应及早行鼻内镜下鼻腔鼻窦探查术;对严重视力障碍、视力急剧下降患者及早实施视神经减压手术,可以有效改善患者的视功能.     

鼻外筛——蝶窦进路视神经管减压术

头面部创伤所致的视神经挫伤临床上以视神经管段损伤最为多见，本文对９例外伤性视神经挫伤病人进行鼻外筛－蝶窦进路视神经管减压术治疗，其中３例视力有所恢复，６例无效。作者认为对伤后视力下降者应作急症手术处理，以鼻外筛－蝶窦进路为最好，减压必须充分。     

Extended indications for decompression of the optic nerve: a differentiating analysis of restriction of the visual function, also in comatose patients

BACKGROUND: The care of indirect traumatic optic neuropathy is still treated differently. Special diagnostic and therapeutic difficulties exist in comatose patients without definable visual acuity and in patients with complex failure of the visual field with central visual acuity still receiving sufficiently. METHOD: The total collective of optic nerve decompressions within the period between January 1992 and August 2000 was comprised of 66 patients. 18 of these 66 patients (average age: 40.5 years) were comatose and required critical care. 3 of the 48 consciousness-clear patients showed post-traumatically different defects of the visual field with a visual acuity of 0.3, 0.4 and 1.0. The indication for surgical decompression in both groups was based on the ophthalmological findings and the CT-finding of traumatization of the optic nerve, or the orbit apex respectively. RESULTS: During the subsequent postoperative examinations (on average 12.3 months postoperatively) five patients within the group of the unconscious patients showed a normal visual acuity (0.9-1.0), 3 patients a visual acuity of 0.7, 0.4 and 0.3 and one a visual acuity of 0.1. Six patients remained amaurotic. Three patients died from the general consequences of injury. Improvement of visual field and correction of stereoscopic function occurred in all patients, operated on primarily because of the described visual defects. CONCLUSIONS: Due to these results the indication for the decompression of the optic nerve should find special consideration in comatose patients and in cases of severe restriction of the visual field.