Chen Yingbai, Tu Yunhai, Chen Ben, Shi Jieliang, Yu Bo, Wu Wencan
Minimally Invasive Surgical Center, Eye Hospital of Wenzhou Medical University, Wenzhou City, China.
Minimally Invasive Surgical Center, Eye Hospital of Wenzhou Medical University, Wenzhou City, China.
Am J Ophthalmol. 2017 Jan;173:1-6. doi: 10.1016/j.ajo.2016.09.022. Epub 2016 Sep 23.
To assess the feasibility and efficacy of endoscopic transnasal removal of cavernous hemangiomas of the optic canal.
Retrospective, noncomparative case series.
Eleven consecutive patients (11 eyes) with cavernous hemangioma of the optic canal underwent endoscopic trans-ethmoidal-sphenoidal removal of the tumor at the Eye Hospital of Wenzhou Medical University from January 2009 to March 2016. In each case, the indication for surgery was decreased visual acuity due to the tumor. The removal was believed to be complete if the tumor was removed en bloc during the surgery. A mucoperiosteal flap was used to cover the defect in the optic nerve sheath after tumor removal. The tumor was pathologically confirmed to be cavernous hemangioma after surgery. The mean follow-up time was 9.9 ± 5.5 months. Visual acuity before and after surgery was compared.
All tumors were completely removed by the endoscopic approach. The best-corrected visual acuity (BCVA) improved after surgery in all patients. The mean preoperative BCVA was 6/30 (95% confidence interval [CI] 6/60-6/20) and the mean postoperative BCVA was 6/10 (95% CI 6/12-6/7.5). All patients showed cerebrospinal fluid rhinorrhea, which resolved with strict bed rest. Other complications included hyposmia in 2 patients; nasal bleeding in 3 patients, which resolved spontaneously; and temporary headache.
Endoscopic trans-ethmoidal-sphenoidal approach is a feasible option for cavernous hemangiomas of the optic canal.
评估经鼻内镜切除视神经管海绵状血管瘤的可行性和疗效。
回顾性、非对照病例系列研究。
2009年1月至2016年3月，温州医科大学附属眼视光医院对11例（11只眼）视神经管海绵状血管瘤患者连续进行了经鼻-筛-蝶窦肿瘤切除术。每例患者的手术指征均为肿瘤导致视力下降。若手术中肿瘤整块切除，则认为切除彻底。肿瘤切除后，使用黏膜骨膜瓣覆盖视神经鞘缺损处。术后病理证实肿瘤为海绵状血管瘤。平均随访时间为9.9±5.5个月。比较手术前后的视力。
所有肿瘤均通过内镜手术完全切除。所有患者术后最佳矫正视力（BCVA）均有提高。术前平均BCVA为6/30（95%置信区间[CI]6/60 - 6/20），术后平均BCVA为6/10（95%CI 6/12 - 6/7.5）。所有患者均出现脑脊液鼻漏，经严格卧床休息后痊愈。其他并发症包括2例嗅觉减退；3例鼻出血，均自行缓解；以及短暂性头痛。
经鼻-筛-蝶窦入路是切除视神经管海绵状血管瘤的一种可行方法。
