Sergott R C, Savino P J, Bosley T M
Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA 19107.
Arch Ophthalmol. 1988 Oct;106(10):1384-90. doi: 10.1001/archopht.1988.01060140548021.
Twenty-three patients with chronic papilledema associated with pseudotumor cerebri underwent "modified" optic nerve sheath decompression for treatment of visual acuity and visual field loss. Instead of removing a single, rectangular section of optic nerve meninges, the operation was modified by making at least three longitudinal incisions in the sheath and then lysing arachnoid adhesions with a tenotomy hook. Twenty-one of the 23 patients demonstrated improved visual function after the initial surgery for a mean (+/- SD) follow-up of 21.5 +/- 12.3 months (median, 25 months; range, three to 45 months) without reoperation or reinstitution or oral corticosteroid and diuretic therapies. The two patients failing to improve after the first surgical procedure initially had a single meningeal window created and subsequently improved following reoperation with the modified procedure. Twelve of 21 patients with bilateral visual loss had improved visual function bilaterally after unilateral surgery. Six of the 21 patients needed bilateral surgery, and the other three had minor visual field defects in the second eye not severe enough to warrant surgery. Preoperative optic disc pallor did not predict a poor postoperative result. Optic nerve surgery improved the visual function in six patients who had failed to recover vision after one or more lumbar-peritoneal shunts.
23例伴有假性脑瘤的慢性视乳头水肿患者接受了“改良”视神经鞘减压术，以治疗视力和视野丧失。手术不是切除单一的矩形视神经脑膜部分，而是进行改良，在鞘膜上至少做三个纵向切口，然后用腱切断钩松解蛛网膜粘连。23例患者中有21例在初次手术后视力功能得到改善，平均（±标准差）随访21.5±12.3个月（中位数，25个月；范围，3至45个月），无需再次手术或重新使用口服皮质类固醇和利尿剂治疗。最初手术失败的2例患者最初做了单个脑膜开窗，随后在采用改良手术再次手术后病情改善。21例双侧视力丧失患者中有12例在单侧手术后双侧视力功能得到改善。21例患者中有6例需要双侧手术，另外3例第二眼有轻微视野缺损，但严重程度不足以进行手术。术前视盘苍白不能预测术后效果不佳。6例在进行一次或多次腰-腹腔分流术后未能恢复视力的患者，经视神经手术视力功能得到改善。
