经颅显微手术治疗额-眶骨纤维结构不良致视神经管狭窄

目的评价经颅显微视神经管减压术在治疗及预防额-眶骨纤维结构不良致视神经管狭窄引起视力下降中的作用及其手术适应证和时机。方法对18例（20侧）因额-眶骨纤维结构不良致视神经管狭窄的患者,进行单侧视神经管减压术16例,双侧视神经管减压术2例,其中治疗性手术14例（15侧）,预防性手术4例（5侧）。结果18例均于术后随访1年9个月至10年,平均34个月。治疗性手术后视力改善3只眼,视力稳定在术前水平10只眼,视力下降2只眼,手术有效率为87%（13/15）;预防性手术后视力均稳定在术前水平,手术有效率为100%（5/5）。结论经颅显微视神经管减压术是治疗及预防额-眶骨纤维结构不良致视力下降的有效方法,对于治疗性手术而言,早期手术视力可望改善。

Transcranial Microsurgery for Optic Canal Stenosis Induced by Fronto-orbital Fibrous Dysplasia

Objectives To evaluate the curative and preventive effect of optic canal decompression by transcranial microsurgery on the decrease in the vision caused by fronto-orbital fibrous dysplasia,and to explore the indications of optic canal decompression.Methods Eighteen patients(20 sides)with optic canal stenosis induced by fronto-orbital fibrous dysplasia were treated by microsurgery through transcranial approach.The clinical manifestations,CT characteristics,surgical techniques and outcomes were analyzed retrospectively.Results Of 18 patients,16 underwent decompression of unilateral optic canal side,and 2 decompression of bilateral optic canals.Of 20 decompression,15 were therapeutic and 5 were prophylactic.The dignosis of fibrous dysplasia of the skull was made by pathological examination in all the patients.The data of following-up from 21 to 120 months showed that improvement of vision was found in 3 eyes(20%,3/15),stability of vision was found in 10 eyes(67%,10/15),and decrease in the vision was found in 2(13%,2/15),and 4 patients(5 sides)undergoing prophylactic operation kept stable vision.Conclusions The optic canal decom-pression by the transcranial microsurgery is an effective method to treat and prevent the decrease in the vision induced by fronto-orbital fibrous dysplasia.Earlier the therapeutic operation was performed,more possibility of improvement of the vision was expected in the patients with optic canal stenoses induced by fibrous dysplasia of skull.