Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Auris Nasus Larynx. 2023 Dec;50(6):895-903. doi: 10.1016/j.anl.2023.03.003. Epub 2023 Mar 24.
To evaluate the causative and risk factors for optic neuropathy with mucocele via imaging studies.
We included 21 patients with rhinogenous optic neuropathy with mucocele. We collected data on the sinus involved, age, sex, number of days from the onset of visual impairment to surgery, and computed tomography (CT) imaging findings (bone defects in the lamina papyracea, Onodi cell mucocele, exophthalmos, and optic nerve deviation). The results were compared between two groups, the one having nine patients with pre-operative visual acuity of <0.1 (the poor group) and the other having 12 patients with pre-operative visual acuity of ≥0.1 (the fair group). Whether or not there was a difference in pre-operative visual acuity between patients with and without Onodi cell mucocele was determined.
After surgery, visual acuity improved in 16/21 (76.2%) patients, and a correlation analysis showed a significant positive correlation between pre-operative and post-operative visual acuity. In imaging, the causative sinuses accounted for 85.7% of both posterior ethmoid and sphenoid sinuses. Bone defects of the lamina papyracea at the optic canal and the vertical downward deviation of the optic nerve at each location, especially in 6/9 patients with Onodi cell mucocele, were characteristic in the poor group. In these conditions, increasing the contact areas of the optic nerve and mucocele can leads to more chances of direct downward compression of the optic nerve and infection occurring, and it may lead to severe pre-operative visual impairment.
Imaging studies of optic neuropathy with mucocele help to determine the risk factors and perform early and precise diagnostic imaging and decision-making for surgery.
通过影像学研究评估鼻源性视神经病变伴黏液囊肿的病因和危险因素。
我们纳入了 21 例鼻源性视神经病变伴黏液囊肿患者。收集了鼻窦受累、年龄、性别、从视力损害到手术的天数以及计算机断层扫描（CT）成像结果（纸样板骨缺损、Onodi 细胞黏液囊肿、眼球突出和视神经偏斜）的数据。将两组患者的结果进行比较，一组 9 例患者术前视力<0.1（视力差组），另一组 12 例患者术前视力≥0.1（视力好组）。比较两组患者术前视力是否存在差异，有无 Onodi 细胞黏液囊肿。
手术后，21 例患者中有 16 例（76.2%）视力改善，相关性分析显示术前和术后视力之间存在显著正相关。在影像学方面，病因鼻窦占后筛窦和蝶窦的 85.7%。视神经管的纸样板骨缺损和每个部位的视神经垂直向下偏斜，尤其是在 6/9 例有 Onodi 细胞黏液囊肿的患者中，在视力差组中具有特征性。在这些情况下，视神经和黏液囊肿的接触面积增加，会导致视神经直接向下受压和感染的机会增加，从而导致严重的术前视力损害。
黏液囊肿性视神经病变的影像学研究有助于确定危险因素，并进行早期、准确的诊断影像学检查和手术决策。
