视神经损伤常见合并症及诊疗策略

Complications of traumatic optic nerve neuropathy and strategy of treatment

目的探讨视神经损伤患者出现的合并症及其产生的原因、症状、诊断及治疗。方法选择478例视神经损伤患者,入院后经过头颅CT、MRI及全脑DSA检查,通过手术及非手术方法进行治疗。手术包括开颅视神经减压术、经鼻镜下视神经减压术;非手术治疗包括使用脱水药物、糖皮质激素、钙离子拮抗剂、神经营养药物以及高压氧治疗。结果视神经损伤常见合并症按产生部位可分为:颅脑损伤、血管源性、神经源性、肌源性、骨源性及其他。其中以颅脑损伤(93.1%)、神经源性(43.9%)及骨源性(78.5%)合并症为主。视神经损伤常见合并症中,颅脑损伤发病率较高;创伤性动脉瘤(1.5%)、颈内动脉海绵窦瘘(2.5%)等血管源性损伤虽然发病率低,但后果严重。结论视神经损伤常见合并症亦关系到患者的生命安全及生存质量,在治疗视神经损伤同时应予以重视并及时处理。

Objective To study the complications, aetiology, symptoms, diagnosis and treatment of traumatic optic nerve neuropathy （TON）. Methods 478 patients admitted to the Neurosurgery Department of Beijing Tongren Hospital during 1997 to 2004 were enrolled and their data were retrospectively analyzed. All the patients had head CT or MRI and DSA in case it was needed. Treatment included operative and non-operative therapy. Operative therapy included trans-cranial optic nerve decompression and trans-nasal endoscopic optic nerve decompression. Non-operative therapy included dyhydrating medications, glucocoritcoid, calcium antagonist, neurotrophic drug and hyperbaric oxygen therapy. Results The common complications of TON included cranial, vessel, neural, muscular, skeletal and others. The cranial, neural, and skeletal complications were common. The morbidity of cranial complications were high; the vessel complications such as traumatic aneurysm and endocarotid cavernous sinus fistula, were low but the mortality was high. Conclusion Complications of TON can threaten patient＇s life and life quality, so it should be treated appropriately seriously and timely.