Bulters Diederik O, Shenouda Emad, Evans Barrie T, Mathad Nijaguna, Lang Dorothy A
Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Southampton, UK.
Acta Neurochir (Wien). 2009 Apr;151(4):325-34. doi: 10.1007/s00701-009-0192-x. Epub 2009 Mar 3.
Visual failure due to optic nerve compression is a common indication for decompressive surgery. Most data only refer to the odds of improvement, deterioration or remaining the same. However, patients frequently wish to know more detail about the outcomes of surgery. Our aim was to assess the visual outcome from optic nerve decompression for visual failure in detail in order to help counsel patients pre-operatively.
Sixty-eight patients undergoing 71 operations to decompress 87 optic nerves between 1991 and 2007 were identified. Thirty-four decompressions were performed via a transzygomatic and 37 via a transbasal approach. Fifty-two patients had meningiomas, 3 pituitary adenomas, 3 craniopharyngiomas, 3 chordomas, 2 adenocarcinomas, 2 fibrous dysplasia, 1 schwannoma, 1 granular pituitary tumour and 1 olfactory neuroblastoma. Visual acuity and fields were recorded pre-operatively, immediately post-operatively, at first follow-up and at most recent follow-up.
Forty-three eyes (49.4%) experienced an improvement in either acuity or fields. Twenty-four (27.5%) were unchanged and 20 (22.9%) deteriorated. Average improvement was 0.88 Snellen lines (logMAR 0.13). Improvement was seen between immediate post-operative acuity and first follow-up in 52%, but 22% suffered a late deterioration after 1 year. There was no relationship between age, duration of symptoms, pathology, approach or redo surgery and visual outcome. There was a complex relationship between pre-operative visual acuity and post-operative improvement and outcome. Better pre-operative acuity predicted better outcome and greater odds of improvement, although patients with poor pre-operative vision had a greater average magnitude of improvement.
Patients experience significant benefit from optic nerve decompression irrespective of pre-operative visual status. Although early decompression is desirable, good results can still be obtained in patients with severe visual failure. Detailed data on visual outcome can help counsel patients pre-operatively to aid decision-making and set expectations.
因视神经受压导致的视力丧失是减压手术的常见适应症。大多数数据仅涉及改善、恶化或维持原状的几率。然而，患者通常希望了解更多关于手术结果的详细信息。我们的目的是详细评估视神经减压治疗视力丧失的视觉效果，以便在术前帮助咨询患者。
确定了1991年至2007年间接受71次手术以减压87条视神经的68例患者。34次减压通过经颧入路进行，37次通过经基底入路进行。52例患者患有脑膜瘤，3例患有垂体腺瘤，3例患有颅咽管瘤，3例患有脊索瘤，2例患有腺癌，2例患有骨纤维异常增殖症，1例患有神经鞘瘤，1例患有颗粒性垂体瘤和1例患有嗅神经母细胞瘤。术前、术后即刻、首次随访和最近一次随访时记录视力和视野。
43只眼（49.4%）的视力或视野得到改善。24只眼（27.5%）无变化，20只眼（22.9%）恶化。平均改善为0.88斯内伦视力行（logMAR 0.13）。52%的患者在术后即刻视力和首次随访之间出现改善，但22%的患者在1年后出现晚期恶化。年龄、症状持续时间、病理、手术入路或再次手术与视觉效果之间没有关系。术前视力与术后改善及结果之间存在复杂关系。术前视力越好，预后越好，改善的几率越大，尽管术前视力差的患者平均改善幅度更大。
无论术前视力状况如何，患者均可从视神经减压中显著获益。虽然早期减压是可取的，但严重视力丧失的患者仍可获得良好的结果。关于视觉效果的详细数据有助于在术前咨询患者，以帮助决策并设定期望。
