摘要
目的探讨眶上外侧入路视神经管减压术治疗创伤性视神经损伤(TON)的临床效果。方法采用回顾性病例系列研究分析2013年12月—2019年6月浙江省湖州市第一人医院收治的23例视神经损伤患者的临床资料,其中男16例,女7例;年龄17~51岁[(34.3±2.2)岁]。视力受损程度:4例指数,4例手动,9例光感,6例无光感。术前视觉诱发电位(VEP)检查15例:5例P100波幅完全消失,10例波幅低于正常值下限且潜伏期延长。受伤至手术时间3 h^14 d[(3.3±0.6)d]。均行眶上外侧入路视神经管减压术,其中11例有硬脑膜裂口,同时行硬脑膜修补术。记录术中所见骨折及硬脑膜撕裂情况、手术时间、术中出血量、住院时间。结合经典视力改善评估方法和世界卫生组织(WHO)低视力及盲目分级标准,比较术前、术后10 d及术后3个月视力情况。采用格拉斯哥昏迷评分(GCS)评估出院时患者意识状态,术后3个月采用格拉斯哥预后评分(GOS)评估患者预后。观察并发症发生情况。结果患者均获随访12~16周[(13.5±2.4)周]。术中显微镜下探查发现所有患者视神经管骨折,3例在额部骨折处伴硬脑膜破裂口,8例筛板碎骨片处伴前颅底硬脑膜破裂口。手术时间108.5~224.3 min[(151.8±30.2)min],其中开颅时间(32.5±8.4)min;术中出血量90.5~165.3 ml[(121.3±15.5)ml];住院时间14~26 d[(19.7±3.4)d]。术后10 d,13例视力改善(57%),5例脱盲(22%),与术前比较差异均有统计学意义(P<0.05)。术后3个月,17例视力改善(74%),9例脱盲(39%),与术后10 d比较差异均有统计学意义(P<0.05)。6例无效,其中4例术前无光感且VEP检查波幅完全消失。所有患者出院时GCS 15分,术后3个月GOS 5分,预后良好。术后1例脑脊液鼻漏,平卧7 d后愈合。余未出现迟发血肿、癫痫、颅内感染等并发症。结论眶上外侧入路视神经管减压术可早期改善视力,提高脱盲率,术后并发症发生率低,功能恢复满意,值得临床推广。
Objective To investigate the effect of decompression of optic nerve canal for traumatic optic neuropathy(TON)via lateral supraorbital approach.Methods A retrospective case series study was performed to analyze clinical data of 23 TON patients admitted to First People's Hospital of Huzhou from December 2013 to June 2019.There were 16 males and 7 females,aged 17-51 years[(34.3±2.2)years].Degree of visual impairment included count fingers in 4 patients,hand motion in 4,light perception in 9 and loss of light perception in 6.Visual evoked potential examination(VEP)was performed in 15 patients before surgery.The amplitude of P100 completely disappeared in 5 patients,and the amplitude of P100 was lower than the lower limit of normal value and the latency prolonged in 10 patients.The time from injury to operation was 3 h-14 days[(3.3±0.6)days].All patients underwent decompression of optic nerve canal via supralateral orbital approach,and dural repair was performed simultaneously in 11 patients with dural rupture.Intraoperative fractures and meningeal tears,duration of operation,blood loss,and hospitalization duration were recorded.Combined with the classical visual acuity improvement assessment method and the World Health Organization(WHO)low vision and blind grading standard,visual acuity was compared before operation,at 10 days and 3 months after operation.Glasgow Coma Scale(GCS)was used to evaluate patients'state of consciousness in the course of the disease.Glasgow Outcome Scale(GOS)was used to evaluate the prognosis.Incidence of complications was observed as well.Results All patients were followed up for 12-16 weeks[(13.5±2.4)weeks].Intraoperative microscopic exploration revealed that all patients had optic nerve canal fracture,3 patients had frontal fracture with dural rupture,and 8 patients had ethmoid bone fragment with anterior skull base dural rupture.The duration of operation was 108.5-224.3 minutes[(151.8±30.2)minutes],including(32.5±8.4)minutes for craniotomy.The intraoperative blood loss was 90.5-165.3 ml[(121.3±15.5)ml].The hospitalization was 14-26 days[(19.7±3.4)days].The visual acuity of 13 patients(57%)improved and 5 patients(39%)relieved from blindness 10 days after operation,showing significant difference compared with the preoperation(P<0.05).The visual acuity of 17 patients(74%)improved and 9 patients(39%)relieved from blindness at 3 months after operation.There was significant difference in visual acuity examined between 10 days and 3 months after operation(P<0.05).Six patients were invalid,and 4 of them had no light perception before operation and the amplitude of VEP examination completely disappeared.All patients had GCS of 15 when left the hospital and GOS of 5 at 3 months after operation.One patient had cerebrospinal fluid rhinorrhea and healed after 7 days of supine position.No secondary hematoma,epilepsy or intracranial infection occurred during follow-up.Conclusion Optic canal decompression via the lateral supraorbital approach can improve visual acuity in early stage and increase the rate of out of blindness,with low postoperative complications and satisfactory functional recovery,which is worthy of clinical application.
作者
赵朝辉
钟兴明
汪一棋
阳建国
蔡勇
费振海
张磊
顾华
杨涛
Zhao Chaohui;Zhong Xingming;Wang Yiqi;Yang Jianguo;Cai Yong;Fei Zhenhai;Zhang Lei;Gu Hua;Yang Tao(Department of Neurosurgery,First Affiliated Hospital of Huzhou Teachers’College,First People's Hospital of Huzhou,Huzhou 313000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2020年第6期531-535,共5页
Chinese Journal of Trauma
关键词
视神经损伤
外科手术
微创性
视神经管减压术
Optic nerve injuries
Surgical procedures
minimally invasive
Optic canal decompression
