外伤性视神经病变经鼻内镜下视神经管减压及综合治疗

目的 回顾外伤性视神经病变经鼻内镜下视神经管减压合并药物治疗的结果,探讨手术适应证.设计回顾性病例系列.研究对象2006年～2010年北京同仁医院耳鼻咽喉头颈外科收治的外伤性视神经病变患者69例（69眼）.方法 患者术前均行视神经管CT检查,除外严重颅脑外伤合并症,行鼻内镜下经筛、蝶窦视神经管减压术,同时给予围手术期激素冲击、营养神经及扩张血管等综合药物治疗.主要指标手术后视力.结果 59例（85.5%）术前CT扫描显示视神经管骨折.67例（97.1%）行视神经管减压术,其中因鞘膜水肿或鞘膜下积血切开神经鞘2例 1例放弃手术 另1例视力自行恢复出院.随诊2～44个月,术后视力改善30例（44.8%）,其中从无光感到有光感18例,视力大于0.1者9例.结论 经鼻内镜视神经管减压联合药物治疗是目前治疗外伤性视神经病变的推荐方法之一,在除外手术禁忌的情况下,应积极手术并结合药物治疗,挽救视力.

Transnasal endoscopic optic nerve decompression combined medicinal therapy for traumatic optic neuropathy

Objective To review the effect of endoscopic optic nerve decompression combined medicinal treatment for traumatic optic neuropathy and to discuss the indication of endoscopic optic nerve decompression. Design Retrospective case series. Participants 69 patients （69 eyes） with traumatic optic neuropathy in Beijing Tongren Hospital from 2006 to 2010. Methods The computed tomography of optic nerve canal were examined before endoscopic optic nerve decompression in order to exclude major brain injury. High-dose steroids, nerve growth factors and vasodilator given perioperatively. Main Outcome Measures The postoperative visual acuity. Results Fractures of optic canal proved by computed tomography existed in 59 eyes（85.5%）. Endoscopic optic nerve decompressions were undertaken in 67 cases （97.1%）, among which the optic nerve sheaths were incised in 2 cases because of edema or hemorrhage in the nerve sheath; one patient refused the surgical intervention; another patient was restored after medicinal therapy. After followed up for 2 to 44 months, 30 patients （44.8%） described improvements in visual acuity, in which 18 of them with no light perception before treatment got light perception after treatment. In 9 of them visual acuity was 0.1 or more. Condusion Transnasal endoscopic optic nerve de- compression combined with medicinal therapy is appropriate for the patients with traumatic optic neuropathy. This procedure provides an access to the potential improvements of vision loss.