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经鼻内镜视神经减压术治疗创伤性视神经病变

Transnasal Endoscopic Optic Nerve Decompression in Post Traumatic Optic Neuropathy.

作者信息

Gupta Devang, Gadodia Monica

机构信息

1Civil Hospital, Ahmedabad, India.

B. J. Medical College, Asarwa, Ahmedabad, Gujarat India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2018 Mar;70(1):49-52. doi: 10.1007/s12070-017-1211-5. Epub 2017 Oct 16.

Abstract

To quantify the successful outcome in patients following optic nerve decompression in post traumatic unilateral optic neuropathy in form of improvement in visual acuity. A prospective study was carried out over a period of 5 years (January 2011 to June 2016) at civil hospital Ahmedabad. Total 20 patients were selected with optic neuropathy including patients with direct and indirect trauma to unilateral optic nerve, not responding to conservative management, leading to optic neuropathy and subsequent impairment in vision and blindness. Decompression was done via Transnasal-Ethmo-sphenoidal route and outcome was assessed in form of post-operative visual acuity improvement at 1 month, 6 months and 1 year follow up. After surgical decompression complete recovery of visual acuity was achieved in 16 (80%) patients and partial recovery in 4 (20%). Endoscopic transnasal approach is beneficial in traumatic optic neuropathy not responding to steroid therapy and can prevent permanent disability if earlier intervention is done prior to irreversible damage to the nerve. Endoscopic optic nerve surgery can decompress the traumatic and oedematous optic nerve with proper exposure of orbital apex and optic canal without any major intracranial, intraorbital and transnasal complications.

摘要

以视力改善的形式量化创伤性单侧视神经病变患者视神经减压术后的成功结果。在艾哈迈达巴德市民医院进行了一项为期5年(2011年1月至2016年6月)的前瞻性研究。共选择了20例视神经病变患者,包括单侧视神经直接和间接创伤患者,这些患者对保守治疗无反应,导致视神经病变,随后视力受损甚至失明。通过经鼻-筛-蝶窦途径进行减压,并在术后1个月、6个月和1年随访时以视力改善的形式评估结果。手术减压后,16例(80%)患者视力完全恢复,4例(20%)部分恢复。内镜经鼻入路对类固醇治疗无反应的创伤性视神经病变有益,如果在神经发生不可逆损伤之前进行早期干预,可以防止永久性残疾。内镜视神经手术可以在充分暴露眶尖和视神经管的情况下,对视神经创伤和水肿进行减压,而不会出现任何严重的颅内、眶内和经鼻并发症。

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