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内镜经鼻视神经减压术治疗外伤性视神经损伤:我的操作方法。

Endoscopic endonasal decompression for traumatic optic nerve injury: how I do it.

机构信息

Department of Neurosurgery, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, 215000, China.

Department of Neurosurgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215000, China.

出版信息

Acta Neurochir (Wien). 2024 Nov 4;166(1):436. doi: 10.1007/s00701-024-06337-y.

DOI:10.1007/s00701-024-06337-y
PMID:39495295
Abstract

BACKGROUND

Endoscopic Endonasal Decompression for Traumatic Optic Nerve Injury has become an established endoscopic technique. However, Poor sphenoid sinus pneumatization often obscures landmarks, elevating the risk to vital neurovascular structures.

METHOD

By decompressing the orbital apex region and determining the contour of the optic nerve, sequential decompression of the medial wall, superomedial wall, and inferomedial wall of the optic canal.

CONCLUSION

This surgical technique can gradually reveal the contour of the optic canal when the anatomical landmarks on the lateral wall of the sphenoid sinus are unclear, ensuring the surgery can be completed safely and effectively.

摘要

背景

经鼻内镜视神经减压术已成为治疗外伤性视神经损伤的一种成熟的内镜技术。然而,蝶窦气化不良常常会使解剖标志变得模糊,增加对重要的神经血管结构的损伤风险。

方法

通过对眶尖区域进行减压,并确定视神经的轮廓,依次对视神经管的内侧壁、上内侧壁和下内侧壁进行减压。

结论

当蝶窦外侧壁的解剖标志不清楚时,这种手术技术可以逐渐显示视神经管的轮廓,确保手术安全有效地完成。

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Traumatic optic neuropathy: a review of current studies.外伤性视神经病变:当前研究综述。
Neurosurg Rev. 2022 Jun;45(3):1895-1913. doi: 10.1007/s10143-021-01717-9. Epub 2022 Jan 16.
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Combination analysis on the impact of the initial vision and surgical time for the prognosis of indirect traumatic optic neuropathy after endoscopic transnasal optic canal decompression.内镜经鼻视神经管减压术后间接外伤性视神经病变预后的初始视力和手术时间的联合分析。
Neurosurg Rev. 2021 Apr;44(2):945-952. doi: 10.1007/s10143-020-01273-8. Epub 2020 Feb 25.
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An evolving perspective of endoscopic transnasal optic canal decompression for traumatic optic neuropathy in clinic.
临床中内镜经鼻视神经管减压术治疗外伤性视神经病变的演变观点。
Neurosurg Rev. 2021 Feb;44(1):19-27. doi: 10.1007/s10143-019-01208-y. Epub 2019 Nov 22.
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Carotid canal and optic canal at sphenoid sinus.蝶窦处的颈动脉管和视神经管。
Neurosurg Rev. 2019 Jun;42(2):519-529. doi: 10.1007/s10143-018-0995-4. Epub 2018 Jun 21.
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Incidence of optic canal fracture in the traumatic optic neuropathy and its effect on the visual outcome.外伤性视神经病变中视神经管骨折的发生率及其对视力预后的影响。
Br J Ophthalmol. 2017 Mar;101(3):261-267. doi: 10.1136/bjophthalmol-2015-308043. Epub 2016 Jun 6.
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Surgery for traumatic optic neuropathy.外伤性视神经病变的手术治疗
Cochrane Database Syst Rev. 2013 Jun 18;6(6):CD005024. doi: 10.1002/14651858.CD005024.pub3.
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Microsurgical anatomy of the orbit: the rule of seven.眼眶显微外科解剖学:七法则
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Endoscopic endonasal approach to the orbital apex and medial orbital wall: anatomic study and clinical applications.经鼻内镜入路至眶尖和眶内侧壁:解剖学研究及临床应用
J Craniofac Surg. 2009 Sep;20(5):1594-600. doi: 10.1097/SCS.0b013e3181b0dc23.
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Sphenoid septations and their relationship with internal carotid arteries: anatomical and radiological study.蝶窦分隔及其与颈内动脉的关系:解剖学与放射学研究
Laryngoscope. 2009 Oct;119(10):1893-6. doi: 10.1002/lary.20623.
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Neurosurgery. 2001 Apr;48(4):827-36; discussion 836-7.