经颅显微减压术治疗创伤性视神经损伤

Microsurgical Decompression of Traumatic Optic Neuropathy via Transcranial Approach

目的探讨经颅入路视神经减压术的手术方法和显微手术技巧,以提高创伤性视神经损伤的手术疗效。方法行减压术治疗创伤性视神经损伤36例,取冠状切口骨瓣开颅(或翼点)入路,在手术显微镜直视下手术,切开颅底硬脑膜,暴露及开放视神经管上壁和外侧壁,显露视神经不少于1/2周径,剪开视神经鞘膜和总腱环。结果本组均术后随访3月以上,28例视力明显提高,7例术后视力未恢复,1例术后视力恶化,无术后并发症。结论适宜的手术时机、合理的手术入路、充分的术中减压和精细的显微外科技巧可显著提高创伤性视神经损伤的手术疗效。

Objective To explore the operative techniques of microsurgical decompression via transcranial approach, and further to improve the therapeutic effects for traumatic optic neuropathy （TON）. Methods All the 36 TON patients were performed the direct microsurgery decompression via the pterion or transcranial approach with coronal incision. After cutting basicranial dura, superior wall and lateral wall of optic canal was opened. Then, at least 1/2 cycle of optic nerve was exposured and the optic nerve sheath and common tendinous ring was opened. Results All cases were followed up at least 3 months. The visual acuity was signifi- cantly improved in 28 cases, no amelioration in 7 cases, and visual degradation in 1 case. No postoperative complication was found. Conclusion The surgical therapeutic effects would be guaranteed for ASO based on appropriate operation opportunity, reasonable approaches, adequate intraoperative decompression, and elaborate microsurgical techniques.