眶尖减压术治疗外伤性眶尖综合征

目的 探讨眶尖减压术治疗外伤性眶尖综合征的疗效。方法 对11例外伤性眶尖综合征患者,根据眶尖区不同受损伤部位,采取不同手术入路的眶尖减压术,其中5例经额入路,6例经翼点入路。术后视力的评价标准分为5个级别：失明、光感、眼前手动、眼前数指和能见视力表符号5个级别。术后视力提高1个级别者为有效,否则为无效。并对眶上裂区神经恢复情况进行评价,有两项神经恢复为有效。结果 术前失明患者6例,3例有效(50％);残存视力患者5例,视力均有不同程度提高;眶上裂区神经均有不同程度的恢复,4例眼球突出均得到矫正。结论眶尖减压术是治疗眶尖综合征的有效方法,可同时治疗合并脑损伤的患者,术后恢复效果与损伤后手术时间、手术方法及神经损伤程度密切相关。（中华眼科杂志,2004,40：804-807)

Traumatic Rollel's syndrome treated with decompression of orbital apex

OBJECTIVE: To observe the efficiency of decompression of orbital apex operation for the treatment of traumatic Rollel's syndrome. METHODS: Eleven patients with Rollel's syndrome were operated using two different approaches of decompression of orbital apex according to the location of the lesion. Five cases were treated by trans-frontal approach and 6 cases by trans-pterion approach. For the purpose of evaluation, the postoperative outcome of visual acuity was classified into five grades: Non-light perception, light perception, hand motion, finger counter and acuity chart. The visual acuity improvement reaching 1 grade or more was defined as effective and less than 1 grade as inefficient. The improvement of nerve injuries in superior orbital fissure was also evaluated, patients with recover of 2 or more nerves was defined as effective. RESULTS: Visual acuity: 3 cases (50%) were classified as effective in non-light perception group, the remaining 5 cases who had residual vision before operation all improved to various extents. The eye position in cases with exophthalmos was return to normal after operation. Injured nerves were recovered in all 11 cases. CONCLUSIONS: Decompression of orbital apex is an effective treatment for patients with Rollel's syndrome and the craniotomy approach can treat the combined brain injury. The recovery after operation is correlated with the timing of surgery, the approach of the operation and also related with the severity of the nerve injury.