Rybaczek Magdalena, Łysoń Tomasz, Sieśkiewicz Michał, Mariak Zenon, Turek Grzegorz, Sieśkiewicz Andrzej
Department of Neurosurgery, Medical University of Bialystok, Bialystok, Poland.
Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
Quant Imaging Med Surg. 2024 Dec 5;14(12):8966-8973. doi: 10.21037/qims-24-1125. Epub 2024 Nov 8.
Transnasal endoscopic decompression of the optic nerve is increasingly gaining acceptance among ear, nose, and throat (ENT) surgeons, however neither strict indications for the procedure nor the precise extent of effective decompression have been firmly established to date. This study aimed to determine the distance between endoscopically visible, anatomical structures within the sphenoid sinus and the posterior (i.e. intracranial) endpoint of decompression. The lateral optico-carotid recess (LOCR) is proposed as a reference for the undertaken measurements.
The precise localizations of the LOCR and the point at which the optic nerve is covered by bone only for 180° of its circumference were determined using high-resolution computed tomography performed in 30 subjects (60 orbits). Reformed high-resolution computed tomography scans, perpendicular to the optic canal, were used for all measurements.
The point at which optic nerve decompression can be safely terminated was identified in proximity to the medial edge of the LOCR: in all cases, no further than 2.5 mm anterior to this landmark (assigned a negative value) and no further than 1.3 mm posterior (assigned positive values), with a mean of -0.4±1.3 mm. When measured from the orbital apex, the distance ranged from 4.8 to 14.4 mm, with a mean of 8.7±2.5 mm.
The LOCR can be directly discernible by the endoscopic surgeon and identified on the reconstructed high-resolution computed tomography scans, offering a reliable landmark for designating the required extent of decompression. Measurements related to the orbital apex proved less credible, and additionally, this landmark is challenging to identify during surgery.
经鼻内镜视神经减压术越来越受到耳鼻喉科（ENT）外科医生的认可，然而，该手术的严格适应症和有效减压的精确范围至今尚未完全确立。本研究旨在确定蝶窦内内镜可见的解剖结构与减压的后（即颅内）端点之间的距离。提出外侧视神经-颈动脉隐窝（LOCR）作为进行测量的参考。
使用30名受试者（60个眼眶）的高分辨率计算机断层扫描确定LOCR的精确位置以及视神经仅在其圆周180°被骨覆盖的点。所有测量均使用垂直于视神经管的重建高分辨率计算机断层扫描。
确定了视神经减压可安全终止的点，该点靠近LOCR的内侧边缘：在所有情况下，不超过该标志前方2.5mm（赋值为负值）且不超过后方1.3mm（赋值为正值），平均值为-0.4±1.3mm。从眶尖测量时，距离范围为4.8至14.4mm，平均值为8.7±2.5mm。
内镜外科医生可直接辨别LOCR，并在重建的高分辨率计算机断层扫描上识别，为确定所需的减压范围提供可靠的标志。与眶尖相关的测量结果可信度较低，此外，该标志在手术中难以识别。
