Endoscopic optic nerve decompression for traumatic optic neuropathy in children

Objectives

To discuss the necessity of nasal endoscopic surgery for pediatric traumatic optic neuropathy and its therapeutic effect.

Methods

We retrospectively reviewed the cases of 41 children (involving 43 eyes) with traumatic optic neuropathies who were treated in our department by endoscopic optic nerve decompression and postoperative corticosteroid in large doses from Feb. 2000 to Apr. 2010. A 6-month follow-up study was performed for each patient in order to observe the postoperative eyesight recovery and analyze the therapeutic effect.

Results

The eyesight of 11 patients out of 41 patients reached 0.2-0.3 postoperatively, the eyesight of 16 patients recovered from counting fingers to 0.1 after the surgery, the eyesight of 6 patients ranged from light sensation to seeing the hand movement, the eyesight of 7 children did not recover from the operation. The prognosis in the children who underwent the decompression 7 days post-traumatically was much worse than other children.

Conclusions

The age of the patients was not the main element influencing the decision-making process for the operation. The main elements affecting the prognosis were the degree of injury and the time interval between the trauma and the time when patients underwent the surgery. The operation opportunity and plan are very important to a successful operation.     

Endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy

Optic nerve decompression has been accomplished by a variety of procedures. Since 1995, endoscopic optic nerve decompression (EOND) has been used to treat traumatic optic neuropathy (TON) patients in our hospital after medical treatment failed. To date, 17 TON patients have received EOND in our hospital and have been followed up for more than half a year. After decompression, vision improved in 9 patients, remained the same in 6, and became worse in 2. The dura was incidentally exposed during the operation in 1 patient. We conclude that it is easier and more precise to perform optic nerve decompression by EOND than by other optic nerve decompression procedures. However, its efficacy still needs further investigation.     

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。     

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。     

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     

Endoscopic orbital and optic nerve decompression

Endoscopic orbital decompression has become the surgical treatment of choice for many patients with orbital manifestations of Graves' disease, including proptosis and optic neuropathy. The unparalleled visualization provided by endoscopic instrumentation allows for a safe and thorough decompression, particularly when operating along the orbital apex and skull base. Although the benefits of and indications for decompression of the orbit are well established, the role of optic nerve decompression remains controversial.     

Endoscopic orbital and optic nerve decompression

The endoscopic transnasal approach is well suited for decompression of both the orbit and optic canal. High-resolution nasal endoscopes provide excellent visualization for bone removal along the orbital apex and skull base. Endoscopic orbital decompression has proved to be safe and effective for the treatment of patients with Graves' orbitopathy; however, the indications and outcomes for endoscopic decompression of the optic nerve remain controversial.     

鼻内镜下视神经减压治疗外伤性视神经病

目的 探讨鼻内镜下视神经减压治疗外伤性视神经病的疗效。方法 对外伤性视神经病患者应用大剂量皮质类固醇治疗,无效者15例行鼻内镜下视神经减压术。术前视力无光感者5例,光感者4例,眼前手动者3例,眼前数指者2例,视力0.1者1例。受伤至术前不足7d 4例,超过7d 11例。结果 术后随访3个月至4年, 9例视力有不同程度提高,总有效率为60%,术前无光感眼有效率为20%,有光感以上视力者术后有效率为80%。结论 鼻内镜视神经减压对外伤性视神经管内段神经病疗效确切、较其他径路创伤较小,尽管超过创伤7d,仍然是一种良好方法。     

视神经减压术治疗创伤性视神经病的疗效观察

目的 观察视神经减压术治疗创伤性视神经病的临床疗效.方法 30例创伤性视神经病患者,分别采用鼻外径路或经鼻内镜筛蝶窦径路施行视神经减压术,观察手术治疗的临床效果.结果 总有效率56.67%.术前无光感的16例中,6例术后视力显示一定程度的改善;术前有残余视力的14例中,11例的术后视力均有不同程度的提高.无1例发生严重并发症.结论 视神经减压术对创伤性视神经病导致的视力障碍,无论伤后时间长短和是否具有残余视力,均具有确切疗效.     

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。     

经鼻视神经减压术相关的内镜解剖学研究

目的：研究视神经和后组鼻窦以及眼动脉的关系,寻找可靠的解剖标志,为经鼻视神经减压手术中视神经定位和有效避免损伤眼动脉提供内镜解剖学基础。方法：选用8例成人头颅标本,采用messerklinger手术方法开放后组筛窦和蝶窦。在内镜下辨认视神经-颈动脉隐窝和视神经管,观察视神经和后组鼻窦的关系,去除骨性管壁,充分开放视神经的颅口和眶口,切开视神经管硬膜层,观察视神经和眼动脉的关系。结果：本组发现在所有标本中均可以观察到颈内动脉一视神经隐窝,视神经隆起出现率仅为62％;视神经和蝶窦以及后组筛窦存在3种毗邻关系,8侧（50％）前部为后筛窦,后部为蝶窦,5侧（31％）全为蝶窦,3侧（19％）全为筛窦;视神经管颅口部眼动脉位于视神经内下方9例（56％）、下方4例（25％）和外下方3例（19％）,眼动脉在视神经下方向外侧行走,至视神经管眶口部,眼动脉位于视神经下方3例（19％）和外下方13例（81％）。结论：视神经一颈内动脉隐窝恒定出现,同时由于内镜的成像特点,该隐窝比视神经管隆起的辨认更加可靠,可以作为视神经减压手术中的首选解剖标志;眼动脉发起的位置位于视神经的下内侧,发出后向下外侧行走,行程中存在交叉关系,手术中应注意该因素,避免损伤眼动脉。     

Endoscopic decompression of the optic nerve in pseudotumor cerebri

Pseudotumor cerebri is a neurological condition in which patients develop headaches and visual loss that may not be successfully treated with medication. In these cases surgery is indicated, and decompression of the optic nerve is the preferred surgical procedure. We report a case of decompression of the optic nerve performed through an endonasal endoscopic approach in a patient with pseudotumor cerebri where enhancement of visual acuity was successful. To our knowledge, no previous investigators have reported this approach to treat pseudotumor cerebri.     

经鼻内镜下视神经减压术39例报告

目的：探讨经鼻内镜下视神经减压术治疗管段视神经损伤的可行性,技巧及优点。方法：回顾性分析39例视神经损伤的病例,伤后2-18d行手术治疗,采用鼻内镜下经鼻视神经减压术,经筛窦或蝶窦自然开口进入蝶窦,寻找视神经管及骨折部位,去除骨管周壁的1.3-1.2,切开视神经鞘膜,明胶海绵及凡士林纱条填塞鼻腔,术后给予药物,高压氧治疗。结果：随访至少3个月,39例患者（40眼）中,5例失访,术后视力发送的总效率为52.5%(21-40）。受伤至手术的时间间隔2-7d手术者,术后视力改善的有效率为58.6%(17-29);7-18d手术者,术后视力改善的有效率为36.1%(4-11)。视力恢复期约2个月。结论：经鼻内镜下视神经减压术具有视野清晰,无需开颅,侵袭性小,头面部不遗留瘢痕,并发症少等优点。手术恢复的程度与视神经损伤的程度,手术时间的选择及手术技巧等因素相关。     

外伤性视神经损伤经鼻内镜视神经减压手术时期选择及疗效观察

目的 观察鼻内镜下视神经减压术治疗外伤性视神经损伤的疗效和最佳手术时间.方法 对1998年4月至2007年3月90例头部和(或)颌面外伤后发生93眼外伤性视神经损伤的患者进行回顾性分析.所有患者接受鼻内镜视神经减压术前对药物治疗均无反应或效果不佳.受伤至手术时间1～97 d,中位手术时间5.5 d.术前无视力71眼,有视力22眼(1眼光感,5眼眼前手动,13眼眼前指数,1眼视力0.04,2眼视力0.1).随访时间6 d～2年,中位随访时间8 d.结果 视神经减压术后35例(36眼,38.7%)视力有改善,53例(55眼,59.1%)无变化,2例(2眼,2.2%)视力下降.术前有视力的患者中,视力改善者达68.2%(15/22眼),外伤后立即或逐渐失明的患者中视力改善分别只有22.9%(8/35眼,仅2眼视力恢复到大于0.02)和36.1%(13/36眼,5眼视力恢复到大于0.02),术前有视力和无视力两组视力术后恢复差异非常显著(X2=11.864,P<0.01).无视力的患者中,伤后3 d内手术视力改善为41.2%(7/17眼),3 d后手术视力改善下降到25.9%(14/54眼),但两者之间差异无统计学意义(X2=1.46,P>0.05).不同受伤部位比较,视神经管内外侧壁同时骨折手术效果最好(55.6%,10/18眼),其次为内侧壁骨折(45.7%,21/46眼),最差为没有骨折(20%,4/20眼)和单纯外侧壁骨折患者(11.1%,1/9眼).结论 为了挽救患者视力,应尽早行鼻内镜视神经减压手术,即使伤后立即丧失视力也不要放弃手术治疗.但手术后所获得的满意的视力恢复仍然需要进一步研究.     

Delayed optic nerve decompression for indirect optic nerve injury

OBJECTIVE: To test the efficacy of delayed optic nerve decompression in traumatic optic nerve injury. STUDY DESIGN: Critical analysis of Proforma-based, prospectively accrued data of all cases with injury to surgery interval of greater than 2 weeks. METHODS: Thirty-five cases with a median injury to surgery interval of 56 days (range, 16-374 d). Surgical decompression was undertaken only in cases that continued to have poor vision after treatment with steroids in conventional doses (1 mg/kg prednisolone). Pre- and postoperative visual acuity measurements were converted to the logMAR scale of visual acuity and the percentage of visual improvement was calculated. RESULTS: Surgery was universally unrewarding in all 9 cases with persistent and complete blindness of greater than 2 weeks and no response to steroid therapy. Of the cases with some residual vision, 20 of 26 cases improved (mean percentage improvement, 41.0 +/- 5.7%). Cases were categorized on the basis of the injury to surgery interval into groups of 2 weeks to 2 months, 2 months to 4 months, and greater than 4 months. No significant difference was demonstrated in the probability or quantum of improvement in these groups (P =.97). CONCLUSIONS: Optic nerve decompression remains useful as a salvage procedure for conventional dose steroid failed cases of traumatic optic neuropathy. In cases that are not completely blind, vision can be improved even when surgery is undertaken a few months after the injury.