神经内镜经筛蝶窦入路视神经管减压术治疗创伤性视神经病变的临床疗效

目的探讨神经内镜经筛蝶窦入路行视神经管减压术治疗创伤性视神经病变(TON)的临床效果。方法回顾性分析2013年12月至2018年2月上海交通大学附属第一人民医院神经外科连续收治的29例(32侧)TON患者的临床资料。术前视力:无光感15侧,光感14侧,指动3侧。所有患者均采用术中神经导航辅助神经内镜经筛蝶窦入路行视神经管减压术治疗。术前均行高分辨率头颅CT扫描,观察手术相关结构的解剖特点,术后观察患者的视力变化以及手术并发症情况。结果29例患者术后随访(5.2±1.1)个月(3~6个月)。术后视力:无光感10侧,光感4侧,指动4侧,指数5侧,最小分辨角的对数(logMAR)视力表≥0.02的9侧,手术有效率为59.4%(19/32)。无一例患者发生颈内动脉损伤、脑脊液鼻漏、嗅觉丧失等手术相关并发症。结论神经内镜经筛蝶窦入路视神经管减压术是治疗TON的有效手段,该手术入路解剖特点清晰,术中神经导航辅助有利于提高手术的安全性,减少手术相关并发症。

Outcome of optic nerve decompression through neuroendoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy

Objective To investigate the outcome of optic nerve decompression through neuro-endoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy(TON).Methods The consecutive clinical data of 29 patients(32 sides)with TON who were treated at Department of Neurosurgery,Shanghai General Hospital,Shanghai Jiao Tong University from December 2013 to February 2018 were retrospectively analyzed.Preoperative visual acuity results were as follows:no light perception(NLP)in 15 sides,light perception in 14 sides,and hand moving in 3 sides.All patients underwent optic nerve decompression through neuroendoscopic transethmoidal-sphenoidal approach assisted with intraoperative neuronavigation.High-resolution skull CT scan was performed before the operation.These aspects were documented including the anatomic landmark observed during operation,visual changes of the patients and operative complications.Results The follow-up periods were 5.2±1.1 months(range:3 to 6 months).Postoperative visual acuity results were as follows:NLP in 10 sides,light perception in 4 sides,hand moving in 4 sides,counting finger in 5 sides,and logMAR≥0.02 in 9 sides.The effective rate of operation was 59.4%(19/32).No surgical complications such as internal carotid artery injury,cerebrospinal fluid rhinorrhea or anosmia occurred.Conclusion Optic nerve decompression through transethmoidal-sphenoidal approach seems to be an effective method for the treatment of TON.The anatomic landmarks of the surgical approach are clearly defined,and intraoperative neuronavigation contributes to the safety of operation and reduces the occurrence of complications.