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目的探讨外伤性视神经损伤的诊断与影像学特点以及显微手术在经颅视神经管减压中的应用和效果。方法总结经颅显微手术视神经管减压治疗外伤性视神经损伤患者17例,分析患者视神经管骨折情况,随访术后6个月的视力变化。结果受伤至减压手术时间为4 h至7 d,显微手术采用翼点入路11例,额下入路4例,眶上锁孔入路2例。术后6个月随访视力改善的总有效率为82.3%,无严重术后并发症。结论经颅显微视神经管减压术对外伤性视神经损伤有较好的疗效,视神经骨性管道充分开放及神经鞘膜的减张可使受伤视神经得到充分减压,从而避免继发性的损害。
Objective To investigate the diagnostic and imaging characteristics of traumatic optic nerve injury and its application in transcranial optic nerve decompression. Methods Twenty-seven patients with traumatic optic nerve injury undergoing transcranial microsurgery of optic canal decompression were analyzed. Visual acuity of the optic canal was analyzed. Visual acuity was assessed at 6 months after the operation. Results The time from injury to decompression surgery was 4 h to 7 days. There were 11 cases of microsurgery using pterional point approach, 4 cases of inferior frontal approach and 2 cases of supraorbital keyhole approach. At 6 months after operation, the total effective rate of visual acuity improvement was 82.3%, without serious postoperative complications. Conclusion Transcranial microscopic optic canal decompression has a good effect on traumatic optic nerve injury. The sufficient opening of the optic nerve bony duct and the reduction of the nerve sheath can fully decompress the injured optic nerve so as to avoid secondary damage .