经颅硬膜外入路骨纤维发育不良性视神经管狭窄减压术疗效分析

目的 探讨视神经管狭窄减压术治疗累及视神经管的骨纤维发育不良的机制、方法、效果及时机.方法 对18例以每侧眼为单位患者行视力、CT、眼底像、OCT检查,手术组21侧行经颅硬膜外入路,其中19侧切除视神经管上壁、外侧壁和内壁病变,另有2侧切除视神经管眶口病变；非手术组15侧随访,其中1侧视力下降后手术.对不同组的视力变化进行非参数检验.结果 治疗性手术组15侧,视力有效率14/15,预防性手术6侧,视力不变(P=0.012),视神经管再次狭窄5侧,其中视力下降1侧(P=o.080).OCT改变符合筛板压力失衡原理.结论 在筛板压力失衡原理指导下,采取经颅硬膜外入路切除视神经管上壁、外侧壁和内壁病变,预防视神经二次损伤效应,可以改善和稳定视力.

Transcranial epidural approach for decompression of optic canal stenosis caused by fibrous dysplasia

Objective To evaluate the mechanism,methods and effects about decompression of stenosis involving optic canal due to fibrous dysplasia through transcranial epidural approach.Method The examination of visual acuity,CT,fundus and OCT of 18 patients of stenosis involving optic canal due to fibrous dysplasia were performed.The patients were divided into 2 groups:operation group and non -operation group.The operation was performed through transcranial epidural approach in 19 sides of optic canals on the upper,outer and inner walls,and 2 sides of optic canals on orbital mouth bones.In non - operationgroup with follow - up,1 eye vision was decreased and then performed operation.Both groups were taken with non - parametric test for vision changes.Results At operation group,the vision was improved( P =0.012),and with recurrence of 5 sides of optic canal stenosis,the visual acuity was decreased in 1 eye ( P =0.080 ).Conclusions With diseqailibrium pressure between lamina cribrosa,transcranial epidural approach for resection of fibrous dysplasia at the upper,outer and inner walls of optic canal could prevent from secondary effect of optic nerve damage and improve and stabilize vision.