眶-筛-蝶联合径路视神经减压术的临床应用

目的 :探讨提高视神经管内段损伤疗效的方法。方法 :采用眶 筛 蝶联合径路对 5 2例视神经管内段损伤进行减压术治疗 ,全程松解视神经。结果 :术后视力得到不同程度恢复者 2 2例 ,视力改善率为 42 .3%。其中继发性视力损伤 2 3例 ,视力提高者占 73.9% ;原发性视力损伤 2 9例 ,视力提高者占 17.2 %。随访 6个月 ,视力恢复至 0 .0 5～ 0 .6。结论 :眶 筛 蝶联合径路视神经减压术进路短 ,视野宽 ,便于操作 ;且解剖标志清楚 ,易定位 ,更安全 ,更适合筛、蝶窦发育不良 ,骨质增生者。

Clinical study of decompression of optic nerve through combined orbit, ethmoid and sphenoid approach

OBJECTIVE: To improve the level of diagnosis and treatment of optic nerve trauma at the canalicular segment. METHOD: Fifty-two patients with optic nerve trauma at the canalicular segment received decompression of optic canal through combined orbit, ethmoid and sphenoid approach. RESULT: The visual improvement rate of all 52 patients was 42.3%, 73.9% in 23 patients with secondary optic trauma and 17.2% in 29 patients with primary optic trauma. Patients's vision covered from 0.05 to 0.6 after six months. CONCLUSION: The advantages of decompression of optic nerve through combined orbit, ethmoid and sphenoid approach include easily operation and location, short approach, wide visual field and clear anatomy mark, so it is very safe and suited for those patients with dysplasia and osteosclerosis of ethmoidal or sphenoidal sinus. Orbital CT scan facilitates the diagnosis of optic canal fracture without false positive results. The curative effect is associated with the type of optic nerve trauma and the chance of surgery. Amaurosis shortly after trauma is a dangerous factor of poor prognosis, but it isn't impossible to improve vision if patients receive operation as early as possible.