改良翼点入路手术减压治疗视神经损伤

目的 探讨颅脑损伤合并视神经损伤手术入路及减压的范围。方法 改良翼点入路开颅手术治疗22例颅损伤合并视神经损伤患者，术中磨除骨性视神经管周径1／2，切开视神经鞘膜、总腱环及镰状韧带，视神经充分减压。视力恢复评价标准：黑矇、光感、眼前手动、眼前数指和能见标字视力表符号5个级别，术后视力提高2个级别以上者为有效。结果 术后3～6月随访，有效率为81．8％。结论 改良翼点入路手术减压治疗视神经损伤效果良好，术后视力恢复与伤后手术时间、手术方法及减压范围有关，亦与其原发损伤程度密切相关。

Surgical decompression of optic nerve iniury in head trauma by improved pterional approach

Objective To study the surgical approach and the decompressing range at the operation of the optic nerve injury in head trauma. Methods 20 cases with optic nerve injury in head trauma were operated on via improved intradural pterional approach to sufficiently decompress optic nerve by means of grinding away 1/2 of girth of the bony optic canal and cutting open the optic nerve sheath, common tendinous ring and falciform ligament. Visual recovering evaluation criterion included 5 visual levels, e.g. blindness, light perception, hand motion, finger counting and acuity chart. The improvement of two visual levels or more was defined as effective, otherwise as inefficient. Results The effective rate of the surgical operation reached 81.8% by regular visits 3 to 6 months after operation. Conclusion The improved intradural pterional approach proves effective in the decompression of optic nerve. Visual recovery is closely relevant to the operation time, approach and decomopressing range as well as original injury.