He Zhenhua, Li Qiang, Yuan Jingmin, Zhang Xinding, Gao Ruiping, Han Yanming, Yang Wenzhen, Shi Xuefeng, Lan Zhengbo
Department of Neurosurgery & Institute of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu Province 730030, People's Republic of China.
Department of Neurosurgery & Institute of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu Province 730030, People's Republic of China.
Clin Neurol Neurosurg. 2015 Jul;134:130-5. doi: 10.1016/j.clineuro.2015.04.023. Epub 2015 May 6.
Traumatic optic neuropathy (TON) is a serious complication of head trauma, with the incidence rate ranging from 0.5% to 5%. The two treatment options widely practiced for TON are: (i) high-dose corticosteroid therapy and (ii) surgical decompression. However, till date, there is no consensus on the treatment protocol. This study aimed to evaluate the therapeutic efficacy of transcranial decompression of optic canal in TON patients.
A total of 39 patients with visual loss resulting from TON between January 2005 and June 2013 were retrospectively reviewed for preoperative vision, preoperative image, visual evoked potential (VEP), surgical approach, postoperative visual acuity, complications, and follow-up results.
All these patients underwent transcranial decompression of optic canal. During the three-month follow-up period, among the 39 patients, 21 showed an improvement in their eyesight, 6 recovered to standard logarithmic visual acuity chart "visible," 10 could count fingers, 2 could see hand movement, and 3 regained light sensation.
Visual evoked potential could be used as an important preoperative and prognostic evaluation parameter for TON patients. Once TON was diagnosed, surgery is a promising therapeutic option, especially when a VEP wave is detected, irrespective of the HRCT scan findings. Operative time between trauma and operation is not necessary reference to assess the therapeutic effect of surgical decompression. The poor results of this procedure may be related to the severity of optic nerve injury. The patient's age is an important factor affecting the surgical outcomes.
创伤性视神经病变（TON）是头部外伤的一种严重并发症，发病率在0.5%至5%之间。广泛应用于TON的两种治疗方法是：（i）大剂量皮质类固醇治疗和（ii）手术减压。然而，迄今为止，对于治疗方案尚无共识。本研究旨在评估经颅视神经管减压术对TON患者的治疗效果。
回顾性分析2005年1月至2013年6月期间39例因TON导致视力丧失的患者的术前视力、术前影像、视觉诱发电位（VEP）、手术方式、术后视力、并发症及随访结果。
所有这些患者均接受了经颅视神经管减压术。在三个月的随访期内，39例患者中，21例视力有所改善，6例恢复到标准对数视力表“可见”，10例能数指，2例能看见手动，3例恢复光感。
视觉诱发电位可作为TON患者重要的术前及预后评估参数。一旦确诊TON，手术是一种有前景的治疗选择，尤其是当检测到VEP波时，无论HRCT扫描结果如何。外伤至手术的时间间隔并非评估手术减压治疗效果的必要参考因素。该手术效果不佳可能与视神经损伤的严重程度有关。患者年龄是影响手术结果的重要因素。
