Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China.
Neurosurg Rev. 2021 Apr;44(2):945-952. doi: 10.1007/s10143-020-01273-8. Epub 2020 Feb 25.
To analyze the impact of the initial vision and surgical time for endoscopic transnasal/transethmosphenoid optic canal decompression (ETOCD) in the treatment of indirect traumatic optic neuropathy (TON). This retrospective case series analysis included 72 patients with indirect TON who underwent ETOCD from August 2017 to May 2019. Visual acuity (VA) was compared before and after surgery to estimate the improvement rate. The overall VA improvement rate of ETOCD was 54.2%. There were 83.3% and 33.3% improvement rate of patients with residual vision and blindness, respectively. VA was improved in 60.9% of patients treated within 3 days, 61.5% treated within 7 days, and 35.0% treated later than 7 days. Of the blindness patients, 50.0%, 37.5%, and 0.0% were treated within 3 days, 3-7 days, and later than 7 days, respectively. Of patients with residual vision, 85.7%, 92.3%, and 70.0% were treated within 3 days, 3-7 days, and later than 7 days, respectively. A statistically significant difference was found between patients with residual vision and those with blindness (P < 0.01), as well as between patients who received ETOCD within 7 days and those who received ETOCD later than 7 days (P = 0.043). The improvement rate of blindness patients managed within 3 days (P = 0.008) and 3-7 days (P = 0.035) was significantly higher than that for patients managed beyond 7 days. Indirect TON patients can directly benefit from ETOCD, and patients with residual vision have better improvement rates. ETOCD should be performed as soon as possible to salvage the patient's VA, especially within the first 7 days. For blindness patients, it is necessary to carry out the surgery within 7 days with increased benefit seen before 3 days.
分析内镜经鼻/经蝶筛窦视神经管减压术（ETOCD）治疗间接性外伤性视神经病变（TON）时初始视力和手术时间的影响。本回顾性病例系列分析纳入了 2017 年 8 月至 2019 年 5 月间接受 ETOCD 的 72 例间接性 TON 患者。通过比较手术前后的视力来评估改善率。ETOCD 的整体视力改善率为 54.2%。有残余视力和失明的患者的改善率分别为 83.3%和 33.3%。在 3 天内接受治疗的患者中，60.9%的患者视力得到改善，在 7 天内接受治疗的患者中，61.5%的患者视力得到改善，而在超过 7 天内接受治疗的患者中，35.0%的患者视力得到改善。在失明患者中，分别有 50.0%、37.5%和 0.0%的患者在 3 天内、3-7 天内和超过 7 天内接受治疗。在有残余视力的患者中，分别有 85.7%、92.3%和 70.0%的患者在 3 天内、3-7 天内和超过 7 天内接受治疗。有残余视力的患者与失明患者之间（P < 0.01），以及在 7 天内接受 ETOCD 的患者与超过 7 天内接受 ETOCD 的患者之间（P = 0.043）差异有统计学意义。在 3 天内（P = 0.008）和 3-7 天内（P = 0.035）接受治疗的失明患者的改善率明显高于超过 7 天接受治疗的患者。间接性 TON 患者可以直接从 ETOCD 中获益，且有残余视力的患者改善率更好。应尽快进行 ETOCD 以挽救患者的视力，特别是在最初的 7 天内。对于失明患者，需要在 7 天内进行手术，且在 3 天内进行手术获益更高。
