Zhang T, Wang J, Yang Z
Department of Otorhinolaryngology, First Affiliated Hospital of Medical College, Jinan University, Guangzhou 510630.
Zhonghua Er Bi Yan Hou Ke Za Zhi. 1999 Jun;34(3):138-40.
To evaluate the key factors in diagnosis, treatment and prognosis of optic nerve trauma at the canalicular segment.
Twenty-six patients with optic nerve dysfunction resulted from trauma to the nerve at canalicular segment were analyzed. All the patients received orbital CT scans, corticosteroid therapy and surgical optic canal decompression through the external ethmoid approach.
With the help of CT scan, the total diagnostic rate was 66.7%; that for canal fracture was 81.3%, for nerve swelling 56.3%. The improvement rate of surgical decompression depended on the time of visual loss and types of toauma. Specifically, the improvement rate was 57.1% in patients with visual loss occurred immediately after the trauma, 83.3% in patients with visual loss occurred a moment after the trauma, 66.7% in patients with optic nerve swelling and 56.3% with optic canal fracture. The possibility of recovery decreased with delay of the surgery.
Orbital CT scan facilitates the diagnosis of optic canal fracture. However, the possibility of traumatic optic nerve dysfunction can not be ruled out in patients without the sign of canal fracture in the CT scan. The key factors in determining nerve recovery were associated with the severity of optic nerve trauma and the chance of surgery. Serious trauma and delay of the surgery may result in the blindness.
评估眶尖段视神经损伤的诊断、治疗及预后的关键因素。
分析26例因眶尖段视神经损伤导致视神经功能障碍的患者。所有患者均接受眼眶CT扫描、皮质类固醇治疗及经鼻外筛窦入路视神经管减压术。
CT扫描总诊断率为66.7%；其中眶壁骨折诊断率为81.3%，视神经肿胀诊断率为56.3%。手术减压改善率取决于视力丧失时间及损伤类型。具体而言，伤后立即视力丧失患者手术减压改善率为57.1%，伤后片刻视力丧失患者为83.3%，视神经肿胀患者为66.7%，视神经管骨折患者为56.3%。手术延迟会降低恢复可能性。
眼眶CT扫描有助于诊断视神经管骨折。然而，CT扫描无骨折征象的患者不能排除外伤性视神经功能障碍的可能。决定神经恢复的关键因素与视神经损伤严重程度及手术时机有关。严重损伤及手术延迟可能导致失明。
