视神经鞘开窗术治疗外伤性视神经鞘脑膜膨出后的视力改善和疼痛缓解
Visual improvement and pain resolution in traumatic optic nerve sheath meningocele treated by optic nerve sheath fenestration.
作者信息
Hui Chen, Xiaoyun Wu, Yi Liang, Ningbo Chen, Xizhong Qiu, Shaowei Yang, Wei Lin, Maozhu Zhao, Wubo Ma, Xuefei Pan, Li Lai, Haibin Tan, Daiwen Zeng, Yong Jiang
机构信息
Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China Laboratory Animal Institute, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China.
Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.
出版信息
Restor Neurol Neurosci. 2014;32(5):655-61. doi: 10.3233/RNN-140395.
PURPOSE
There is no consensus as to the optimum treatment for traumatic optic neuropathy (TON). The decision to intervene medically or surgically, or simply observe was recommended to be on an individual basis. The purpose of this study is to test whether optic nerve sheath fenestration (ONSF) could improve vision in patients with traumatic optic nerve sheath meningocele, although it was reported to be effective in patients with traumatic optic nerve sheath hematoma.
METHODS
ONSF was performed on two traumatic patients with dilated optic nerve sheath from MRI.
RESULTS
Both patients initially suspected as traumatic optic nerve sheath hematoma were diagnosed as traumatic optic nerve sheath meningocele by intraoperative findings of the enlarged optic nerve sheath and clear fluid drained without evidence of blood in the subdural space. Moreover, significant orbit/head pain resolution and visual improvement within a week after ONSF was found.
CONCLUSIONS
When TON presents with an enlarged optic nerve/sheath on CT or MRI with visual loss, an optic nerve sheath meningocele should be considered with the consideration that ONSF may benefit both visual acuity and post-traumatic pain, if present.
目的
对于创伤性视神经病变（TON）的最佳治疗方法尚无共识。建议医疗干预、手术干预或单纯观察的决定应因人而异。本研究的目的是检验视神经鞘开窗术（ONSF）是否能改善创伤性视神经鞘脑膜膨出患者的视力，尽管据报道该方法对创伤性视神经鞘血肿患者有效。
方法
对两名MRI显示视神经鞘扩张的创伤患者实施了ONSF。
结果
两名最初疑似创伤性视神经鞘血肿的患者，术中发现视神经鞘扩大且引流的清亮液体在硬膜下间隙无血液迹象，诊断为创伤性视神经鞘脑膜膨出。此外，发现ONSF术后一周内眼眶/头部疼痛明显缓解，视力改善。
结论
当TON在CT或MRI上表现为视神经/鞘扩大且伴有视力丧失时，应考虑创伤性视神经鞘脑膜膨出，同时考虑到如果存在ONSF可能对视敏度和创伤后疼痛均有益。
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