颅脑损伤并发球后视路损伤的手术治疗

作者于近年来收治１５例颅脑损伤并发视力障碍的患者，均经手术治疗。１３例行双额部冠状切开头皮，一侧额部开颅清除眶骨骨折片或出血，矫正额眶骨折错位畸形。有视神经管骨折者，用微钻磨开视神经管，剪开神经鞘进行视神经减压。２例视力障碍伴有眶上裂综合征者行额颞切口，经眶尖外侧壁磨开骨折眶上裂和视神经管，行神经减压。结果：１０例（６５．９％）有效，３例突眼和１例眼球陷入患者均得到矫正。结论：经额颞入路手术减压可对颅脑损伤并发视力障碍取得良好效果。

Surgical treatment of optic neuropathy after head trauma

We studied the surgical treatment of patients with optic nerve injury following craniocerebral trauma.Fifteen patients aged 17 to 42 years sustained optic neuropathy after head trauma.Single lateral frontal injury occurred in 11 patients,bilateral frontal injury in 3 and temporal injury in one.After head trauma,8 patients with visual acuity impairment had no light perception,including 3 patients who had bilateral eyelosing light perception,5 patients who had only light perception,one who patient can count fingers. In addition, 2 patients compromised supraorbital fissure syndrome,3 patients complicated exophthaloms,and one patients did enophthaloms.Thirteen patients underwent frontal craniotomy with bicoronal skin flap.Operative procedure obtained the lift of depressed orbital fragment,debridement of hemorrhage, and stabilization of displacement bone.The suprawall of optic canal was opened with microb drill,and longitudinal incision was performed in relatively avascular regions of the optic nerve sheath.Lateral orbital wall approach through peritoneal incision entered the orbital apex in 2 patients with supraorbital fissure syndrome,in who in decompression of suprorbital fissure and optic nervous canal were completed.For the purpose of analysis,the outcome of improvements of visual acuity after surgery was classified into five grades:no light perception,light perception,hand motion,counting fingers,and seeing acuity chart.Visual acuity improvements reaching 2 grade or more were determined as effective,and less than 2 grade as inefficient.All patients were followed up for intervals of 1 month,3 months,and 6 months.Ten of 15 patients,who had no postoperative complication,showed the improvement of their visual acuity.Exophathaloms was recovered in 3 patients,and so did in one patient enophthaloms.Transcranial approach may be a safe and effective treatment for the treatment of traumatic optic neuropathy in the orbital,intracranial,and optic canal segments after head trauma.