显微手术治疗外伤性视神经损伤

Microsurgical treatment of traumatic optic neuropathy

目的总结经额入路行显微视神经减压术辅助药物治疗对外伤性视神经损伤的疗效,探讨其治疗原则。方法16例患者经额或额颞入路开颅,显微镜下清除骨折或出血,磨开视神经管,剪开视神经鞘行视神经减压;辅以大剂量皮质类固醇激素、能量合剂和神经营养药物。结果15例患者随访6个月至1年,10例有效,视力不同程度恢复,1例失访。结论经额或额颞入路开颅行显微视神经减压是治疗外伤性视神经损伤有效方法,辅以药物的显微外科治疗是治疗外伤性视神经损伤的一种较理想的治疗方案。

Objective To observe the visual outcome of traumatic optic neuropathy treated with optic canal decompression microsurgery and medication and to investigate the therapeutic principle of traumatic optic neuropathy.Methods In 16 patients with optic nerve injuries after head injury,transfrontal or transfrontotemporal craniotomy was performed,bony fragments or hemorrhage removed,the optic canal decompressed and optic nerve sheath under microscopy opened.All patients received medication at the same time.Results Among the 16 patients,15 were followed up from 6 months to one year,and the visual acuity was improved in 10 patients.Conclusion Microsurgery through tansfrontal or frontotemporal approach may be an effective treatment for traumatic optic neuropathy after head injury.Comprehensive therapy may be an ideal treatment for traumatic optic neuropathy.