Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Chungcheongnam-do, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Najran University College of Medicine, Najran, Saudi Arabia.
World Neurosurg. 2020 Jun;138:e260-e266. doi: 10.1016/j.wneu.2020.02.080. Epub 2020 Feb 24.
Sinonasal fibro-osseous tumors involving the skull base sometimes result in the encasement of the optic canal and can cause the compressive optic neuropathy. This study aimed to elucidate the optimal timing of endoscopic optic nerve decompression (OND) in cases with optic neuropathy caused by fibro-osseous tumors.
Medical records were reviewed retrospectively from July 2008 through November 2016. Subjects who underwent surgery with endoscopic OND for optic neuropathy caused by fibro-osseous lesions were enrolled. Pre- and postoperative ophthalmologic evaluation were analyzed, including best-corrected visual acuity, visual field testing, and color vision.
A total of 9 patients underwent OND. Seven patients had fibrous dysplasia and 2 patients had juvenile ossifying fibroma. Patients included 6 boys and 3 girls. The average age was 15 years with a range of 8-17 years. Symptom duration ranged from 2 months to 4 years. The mean follow-up period was 28 months (range, 0.8-76.4 months). There was no immediate deteriorated vision after OND. Eight eyes (88.9%) were improved and 1 eye (11.1%) had only visual field improvement. However, patients whose visual impairment was in the range of finger count and hand motion were not recovered beyond the quantitatively measurable level even after OND.
Endoscopic OND in patients with optic neuropathy caused by a fibro-osseous tumor in the sinonasal region is safe and worth trying to improve visual outcomes. Early therapeutic OND is recommended before the patient's visual function is decreased below quantitatively measurable vision.
累及颅底的鼻窦骨纤维性肿瘤有时会包裹视神经管，导致压迫性视神经病变。本研究旨在阐明内镜视神经减压术（OND）治疗因骨纤维性肿瘤引起的视神经病变的最佳时机。
回顾性分析 2008 年 7 月至 2016 年 11 月期间因骨纤维性病变引起视神经病变而行内镜 OND 手术的患者。分析术前和术后眼科评估，包括最佳矫正视力、视野检查和色觉。
共 9 例患者接受了 OND。7 例为纤维结构不良，2 例为幼年骨化性纤维瘤。患者包括 6 名男孩和 3 名女孩。平均年龄为 15 岁，范围为 8-17 岁。症状持续时间从 2 个月到 4 年不等。平均随访时间为 28 个月（范围为 0.8-76.4 个月）。OND 后无立即视力恶化。8 只眼（88.9%）视力改善，1 只眼（11.1%）仅视野改善。然而，视力损害范围在指数和手动视力的患者，即使在 OND 后，也无法恢复到定量可测量的水平以上。
内镜 OND 治疗鼻窦骨纤维性肿瘤引起的视神经病变是安全的，值得尝试以改善视力预后。建议在患者的视觉功能下降到定量可测量的视力以下之前，早期进行治疗性 OND。
