Gellrich N-C, Kankam J, Maier W, Aschendorff A, Klenzner T, Schipper J
Klinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover.
HNO. 2006 Oct;54(10):761-7. doi: 10.1007/s00106-006-1387-6.
Surgical optic decompression after trauma has been discussed controversially. The surgical trauma is supposed to produce an additional nerve lesion with the danger of complete loss of vision. Alternatively, conservative high dose cortisone therapy has been recommended.
The functional and morphological consequences of a lesion after calibrated optic compression in one or two sessions were examined in an animal model using 29 Wistar rats.
Depending on the duration and intensity of the lesion, we observed a linear decline in the number of neurons in the RGC (retinal ganglion cell) layer as well as an increasing reactivity to GFAP (glial fibrillary acidic protein) as an indication of central gliosis of astrocytes; however, this was independent on whether optic compression was performed in one or two sessions.
To reduce secondary damage to the visual nerve and the central visual system that might increase with a persisting lesion, the indication for surgical relief of an eye affected by afference should be considered liberally, especially in view of the low morbidity of rhinosurgical intervention.
创伤后手术性视神经减压一直存在争议。手术创伤被认为会造成额外的神经损伤,存在视力完全丧失的风险。另外,有人推荐采用大剂量皮质类固醇保守治疗。
使用29只Wistar大鼠建立动物模型,研究在一或两个疗程中经校准的视神经压迫损伤后的功能和形态学后果。
根据损伤的持续时间和强度,我们观察到视网膜神经节细胞(RGC)层中神经元数量呈线性下降,以及作为星形胶质细胞中枢胶质增生指标的胶质纤维酸性蛋白(GFAP)反应性增加;然而,这与视神经压迫是在一个疗程还是两个疗程中进行无关。
为减少因持续性损伤可能增加的对视神经和中枢视觉系统的继发性损害,对于受传入影响的眼睛,应放宽手术减压的指征,尤其是考虑到鼻科手术干预的低发病率。