前颅窝底骨折合并视神经损伤的治疗

目的分析前颅窝底骨折合并视神经损伤的手术疗效。方法回顾性总结19例前颅窝底骨折所致视力障碍患者的临床资料，依据术前患者头颅SCT轴位和冠状位眼眶及视神经管薄层扫描，将患者分为A、B两组。A组共7例为组成眶顶的额骨眶部和筛骨筛板骨折，术前患者失明，行眶内减压。B组共12例为视神经管骨折，术前患者有不同程度的视力障碍，行视神经管减压。结果A组经眶内减压术后，视力恢复快而且明显，B组经视神经管减压术后视力有不同程度的恢复。两组术后均未出现脑脊液漏等并发症。结论对于颅脑外伤引起失明的患者，要进行充分的术前评价，如为眶顶骨折引起眶内段视神经间接损伤所致失明，一旦明确诊断即行眶内减压治疗，不但可以挽救患者的视力，而且修补硬脑膜可以预防脑脊液鼻漏；对于视神经管骨折引起视力障碍的患者应争取早期手术治疗。

The treatment of traumatic optic neuropathy resulted from fracture of frontal skull base or optic nerve canal

Objective To evaluate visual recovery from traumatic optic neuropathy resulted from the fracture of frontal skull base or optic nerve canal. Methods Summarized the clinical data of the patients with traumatic optic neuropathy retrospectively. The patients were classified into group A, B on their head SCT image. The group A, 7 cases, was the patients with frontobasilar fracture and visual loss. The decompression of intraorbit was performed on the patients. The group B, 12 cases, was that with fracture of optic nerve canal and visual disfunction. The decompression of optic nerve canal was performed. Results All the patients recovered their useful vision after operation in group A and most of the patients in group B improved their vision. There was no CSF leakage after operation in all the patients. Conclusion The optic neuropathy resulted from head trauma should be evaluated seriously. If the visual loss of the patient was caused by the indirect injury of intraorbit optic nerve, the decompression of intraorbit should be performed no matter how long the no light perception lasted. The patient could recovery his useful vision after operation. To the patients with optic nerve canal fracture, the decompression should be performed early.