Thaker Alok, Tandon Dev Ashish, Mahapatra Ashok K
Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
Skull Base. 2009 Jul;19(4):263-71. doi: 10.1055/s-0028-1114299.
To evaluate the benefits and risks of performing an optic nerve sheath incision to supplement standard osseous optic canal decompression for traumatic optic neuropathy.
Before-after analysis of 57 cases undergoing optic nerve decompression at a tertiary referral centre from 1988-2006. Fifty-five cases had adequate post surgical follow-up for evaluation for improvement. Group A (n = 35) had decompression of the osseous optic canal and surgical slitting of the optic nerve sheath; Group B (n = 22) had osseous decompression alone. The groups were comparable for age, injury severity, and injury-surgery interval.
Percentage visual improvement, which was calculated by conversion of the pre- and post-intervention visual acuity measurements to the logarithm of the minimum angle of resolution (logMAR) scale.
No significant recovery was noted in subjects with persistent complete blindness (PL-ve vision). In subjects with residual pre-op vision, the quantum of recovery was greater in Group A than in Group B (46% and 33% respectively, p = 0.10). The difference was especially evident in subjects with no optic canal/posterior orbit fracture (p = 0.07). Three cases with the sheath incision developed transient CSF rhinorrhea in the initial experience, but this was subsequently alleviated with modification of surgical technique.
The addition of optic nerve sheath incision to osseous decompression may improve recovery in optic nerve injury, especially in subjects without optic canal fracture.
评估行视神经鞘切开术以辅助标准的骨性视神经管减压术治疗外伤性视神经病变的获益与风险。
对1988年至2006年在一家三级转诊中心接受视神经减压术的57例患者进行前后对照分析。55例患者术后有足够的随访时间以评估视力改善情况。A组（n = 35）接受骨性视神经管减压术及视神经鞘手术切开；B组（n = 22）仅接受骨性减压术。两组在年龄、损伤严重程度及损伤至手术间隔时间方面具有可比性。
视力改善百分比，通过将干预前后的视力测量值转换为最小分辨角对数（logMAR）量表来计算。
持续性完全失明（无光感视力）的患者未观察到明显恢复。在术前有残余视力的患者中，A组的恢复量大于B组（分别为46%和33%，p = 0.10）。在没有视神经管/眶后骨折的患者中，这种差异尤为明显（p = 0.07）。在最初的经验中，3例行鞘切开术的患者出现了短暂性脑脊液鼻漏，但随后通过改进手术技术得以缓解。
在骨性减压术基础上加用视神经鞘切开术可能改善视神经损伤的恢复情况，尤其是在没有视神经管骨折的患者中。
