摘要
目的 探讨颅脑创伤合并视神经损伤的治疗方法。方法 经手术治疗20例颅脑创伤合并视神经损伤患者,17例经额下入路行额冠状皮瓣一侧额部开颅;3例眶上裂综合征患者行额颞切口,经眶尖外侧壁入路。评价手术后视力恢复的标准为:黑朦、光感、眼前手动、眼前数指和能见标字视力表符号5个级别。术后视力提高2个级别以上者为有效,否则为无效。结果 手术后65％(13例)的患者达到有效,其中3例眼球突出、1例眼球内陷患者术后均得到矫正。结论 颅脑创伤合并视神经损伤患者。经额部或额颞入路手术行视神经减压,可取得良好效果。术后视力恢复与损伤后手术时间、手术方法相关,亦与视神经损伤程度有密切关系。
Objective The surgical effect on the optic nerve injury in head trauma was studied. Methods Twenty patients with optic nerve injury in head trauma aged from 17 to 42 years (mean, 28.5 years) were operated . Blindness occurred in eleven patients, with light perception in seven patients compromised the orbital apex syndrome, three patients complicated with exophthalmus, and one patient with enophthalmos. Seventeen patients received transfrontal craniotomy with the bicoronial skin flap. The operative procedure consisted of lifting the fragment, depressing the orbit, debridement of hemorrhage, and stabilization of displacement orbital fracture. The upper wall of the optic canal was drilled and the optic sheath was opened with longitudinal incision in the relatively avascular region. The opened trauma of ethmoid sinus or ethmoid bone fractures were tightly closed with temporal muscle to avoid the cerebral spinal fluid leakage after operation. The transfrontotemporal craniotomy was performed in three patients approaching to the lateral orbital wall, the superior orbital fissure, and the orbital apex was decompressed by removing bony fragments and hemorrhage and opening the optic nerve sheath. For the purpose of evaluation, the postoperative outcome of visual acuity was classified into five grades: blindness, light perception, hand motion, finger counter, and acuity chart. The visual acuity improvement reaching two grades or more was defined as effective, and less than two grads as inefficient. Results All patients were followed up from 1 month to 12 months. Thirteen of twenty(65% ) patients became effective in visual acuity recovery. Three patients were cured of exophthalmus and so done the three patients with exophthalmus and the one with exophthalmus. Conclusion The tansfrontal or frontotemporal approach may be an effective and safe treatment for patients with the traumatic optic neuropathy. The visual acuity recovery after head injury is correlated with the timing of surgery and operative approach and also associated with the severity of optic nerve injury.
关键词
外科减压术
脑损伤
视神经损伤
Decompression, surgical Brain injuries Optic nerve
