鞍区肿瘤术后突发视力下降的临床分析

Clinical analysis of sudden eyesight decline after operation on sellar tumor

目的探讨鞍区肿瘤术后突发视力下降的原因,提高手术疗效.方法对2003～2004年18例鞍区肿瘤病人经颅手术后视力下降的原因进行分析,对术后出现突发的视功能障碍,在排除了颅内再出血及颅高压后,给以高压氧治疗的同时,静脉使用解痉、扩血管药物及激素和神经营养药物,及时进行腰穿行脑脊液置换,放出血性脑脊液.结果视力恢复至术前水平8例,视力改善＞0.1 3例,视力改善＜0.1 4例,无改善失明3例.结论对这一类术中没有对视神经及视交叉造成直接损伤,其术后当天亦没有视力变化,在术后第2天或第3天出现突起的视力进行性下降的病人,经积极的综合治疗后多能改善其预后,取得满意的效果.

Objective To study the causes of decreased eyesight of the patient after operation on sellar tumor, so as to improve the curative effects. Methods We analyzed the 18 patients with sellar tumors resected through craniotomy from 2003 to 2004, focusing on the causes of decreased eyesights happening on the second day right after operation. We found such main causes leading to worsening of their eyesights as operative stretch injury, prompt decompression, cerebral vasospasm and thermal effect from bipolar coagulator. The sudden visual dysfunction was treated by hyperbaric oxygen, venous administration of spasmolytics, vasodilators, hormones and neural nutrients, and lumbar puncture was performed to replace cerebrospinal fluid. Results 8 cases recovered to the former, 3 improved to above 0.1, 4 below 0.1, and 3 cases lost their eyesights. Conclusion Craniotomy may cause sudden decline of eyesights in some patients with sellar tumor on the second day after operation, even though it produces no direct indury to optic nerves and no changes in eyesights occur. In this case, active and combined therapy is promising to improve the prognosis and achieve satisfactory curarive effect.