Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu Province, China.
J Craniofac Surg. 2023 Jun 1;34(4):1304-1307. doi: 10.1097/SCS.0000000000009327. Epub 2023 Apr 27.
This study aimed to evaluate the safety and accuracy of the endoscopic transethmoid-sphenoid approach for optic canal decompression. Twelve sides of 6 adult cadaveric heads fixed in formalin were selected to simulate optic canal decompression using the endoscopic transethmoid-sphenoid approach. Furthermore, this approach was used for optic canal decompression in 10 patients (11 eyes) with optic nerve canal injury. Related anatomical structures were observed using a 0-degree endoscope, and the anatomical characteristics as well as the surgical data were collected. The maximum effective widths of the cranial opening, orbital opening, and middle segment of the canal that could be drilled open endoscopically were 7.82±2.63, 8.05±2.77, and 6.92±2.01 mm, respectively. The angle between the line linking the center point of the tubercular recess with the midpoint of the cranial opening of the optic canal and the horizontal coordinate was 17.23±1.34 degrees. At the orbital opening of the optic canal, the ophthalmic artery was located directly inferior to the optic nerve in 2 cases (16.7%) and laterally inferior to the optic nerve in 10 cases (83.3%). Six of the operational eyes were effective while the remaining 5 were ineffective. No postoperative complications such as bleeding, infection, or cerebrospinal fluid leakage were observed during the follow-up period (6-12 mo). In conclusion, optic canal decompression positively impacts the prognosis of partial traumatic optic neuropathy. Furthermore, the endoscopic transethmoid-sphenoid approach for optic canal decompression is a minimally invasive procedure that provides direct access and adequate decompression. This technique is easy to master and suitable for clinical applications.
本研究旨在评估经鼻内镜蝶窦入路视神经管减压术的安全性和准确性。选择 6 具福尔马林固定成人尸头的 12 侧，模拟经鼻内镜蝶窦入路视神经管减压术。此外，10 例（11 眼）视神经管损伤患者采用该入路行视神经管减压术。使用 0 度内镜观察相关解剖结构，收集解剖学特征和手术数据。可经内镜钻开颅口最大有效宽度、眶口最大有效宽度和管中段最大有效宽度分别为 7.82±2.63、8.05±2.77 和 6.92±2.01mm。连接颅口中点与视神经管颅口中点的线与水平坐标之间的夹角为 17.23±1.34 度。在视神经管眶口，2 例（16.7%）眼动脉直接位于视神经下方，10 例（83.3%）眼动脉位于视神经外侧下方。6 只手术眼有效，5 只无效。随访 6-12 个月期间，无术后出血、感染或脑脊液漏等并发症。总之，视神经管减压术对视神经部分外伤性病变的预后有积极影响。经鼻内镜蝶窦入路视神经管减压术是一种微创入路，可提供直接入路和充分减压。该技术易于掌握，适合临床应用。
