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颅内肿块存在时脑积水对视神经的影响。

The Effect of Hydrocephalus on the Optic Nerve in the Presence of Intracranial Mass.

机构信息

Department of Neurosurgery, Dicle University School of Medicine, Diyarbakir, Turkey.

Department of Neurosurgery, Dicle University School of Medicine, Diyarbakir, Turkey.

出版信息

World Neurosurg. 2024 Jul;187:e656-e664. doi: 10.1016/j.wneu.2024.04.142. Epub 2024 May 3.

Abstract

OBJECTIVE

The measurement of optic nerve sheath diameter is a noninvasive, practical, and economical method used to identify increased intracranial pressure. The purpose of this study is to detect the preoperative and postoperative changes in optic nerve sheath diameter in patients with intracranial mass, to correlate these changes with optic nerve diameter variations, and to evaluate the impact of hydrocephalus on these alterations.

MATERIAL AND METHOD

This study was conducted with patients who presented to our clinic with complaints of intracranial mass, were decided for surgery, and underwent surgical procedures.

FINDINGS

The optic nerve and optic nerve sheath diameter measurement values were different preoperatively and postoperatively, with a significant decrease in the optic nerve sheath diameter in all groups in postoperative measurements, while the optic nerve diameter significantly increased.

CONCLUSIONS

Although there was no significant difference between the effects of hydrocephalus and intracranial mass-related increase in intracranial pressure on the optic nerve and optic nerve sheath, it was observed that hydrocephalus increased intracranial pressure when considering the Evans ratio. It has been determined that as ventricular dilatation increases, so does intracranial pressure, which leads to an increase in the diameter of the optic nerve sheath, resulting in papilledema and thinning of the optic nerve. These findings indicate the importance of early cerebrospinal fluid diversion and monitoring optic nerve sheath diameter in the management.

摘要

目的

视神经鞘直径的测量是一种非侵入性、实用且经济的方法,用于识别颅内压增高。本研究旨在检测颅内肿块患者术前和术后视神经鞘直径的变化,将这些变化与视神经直径的变化相关联,并评估脑积水对这些改变的影响。

材料和方法

本研究纳入了因颅内肿块就诊并决定手术且接受手术治疗的患者。

结果

视神经和视神经鞘直径的测量值在术前和术后不同,所有组的视神经鞘直径在术后测量中均显著减小,而视神经直径显著增加。

结论

尽管脑积水和与颅内压升高相关的颅内肿块对视神经和视神经鞘的影响之间没有显著差异,但考虑到 Evans 比值,观察到脑积水会增加颅内压。已经确定,随着脑室扩张的增加,颅内压也会增加,这会导致视神经鞘直径增加,导致视盘水肿和视神经变薄。这些发现表明在治疗中早期进行脑脊液引流和监测视神经鞘直径的重要性。

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