Luxenberger W, Stammberger H, Jebeles J A, Walch C
University Ear, Nose and Throat Hospital, Graz, Austria.
Laryngoscope. 1998 Jun;108(6):873-82. doi: 10.1097/00005537-199806000-00016.
Recommendations for management of traumatic injuries to the optic nerve in the literature include expectant management, medical therapy, surgical treatment, and medical therapy combined with surgical decompression. Traditional surgical approaches to optic nerve decompression (OND) are a neurosurgical or craniotomy approach, extranasal transethmoidal approach, transorbital approach, transantral approach, and intranasal microscopic approach. Recent advances in instrumentation and surgical techniques have made an endoscopic approach to OND possible. Since 1991 endonasal endoscopic decompression of the optic nerve has been the surgical approach of choice in patients requiring OND in the authors' hospital. The endoscopic method offers many advantages over the traditional approaches. Decreased morbidity, preservation of olfaction, rapid recovery time, more acceptable cosmetic results with no external scars, no risk of injury to the developing teeth in children, and less operative stress in a patient who may have multisystem trauma are only some of the benefits associated with the endoscopic OND. The authors' technique of endonasal endoscopic approach to OND, medical management, and indications for surgery and the results in 22 patients undergoing this procedure are discussed.
文献中关于视神经创伤性损伤的处理建议包括观察等待、药物治疗、手术治疗以及药物治疗联合手术减压。传统的视神经减压手术方法有神经外科或开颅手术入路、鼻外经筛窦入路、经眶入路、经上颌窦入路以及鼻内显微入路。器械和手术技术的最新进展使得内镜下视神经减压成为可能。自1991年以来，鼻内镜下视神经减压术一直是作者所在医院对视神经减压有需求患者的首选手术方法。与传统方法相比，内镜方法具有许多优势。发病率降低、嗅觉保留、恢复时间快、美容效果更佳且无外部瘢痕、对儿童恒牙胚无损伤风险以及对于可能有多系统创伤的患者手术应激较小，这些只是与内镜下视神经减压相关的部分益处。本文讨论了作者的鼻内镜下视神经减压术技术、药物治疗、手术适应证以及22例接受该手术患者的结果。
