外伤性视神经损伤的HRCT及MRI表现

HRCT and MRI manifestations of traumatic optic neuropathy

目的探讨外伤性视神经损伤的HRCT及MRI表现。方法对19例外伤致盲患者的HRCT及MRI表现进行回顾性分析。结果①19例患者均接受HRCT检查。19例中,16例存在34处视神经管壁骨折,以神经管内侧壁及下壁骨折多见,3例无骨折;视神经管邻近结构骨折共77处,包括眶尖部眼眶骨折23处,蝶骨大翼近眶上裂、眶下裂处骨折15处;蝶骨平台近视交叉沟处骨折11处,蝶窦侧壁骨折2处,眶壁前部、额窦及上颌窦窦壁骨折26处;13例患侧视神经局部较对侧增粗。②10例患者接受MR检查,14处视神经局部信号增高,其中眶内段6处、管内段5处、颅内段3处。③19例患者均接受视神经管减压术治疗,13例在术后7天内即出现不同程度的视力改善。结论外伤后行视神经管HRCT检查可明确视神经管与邻近结构的骨折情况,而MRI对显示视神经具有优势,尤其对无视神经管骨折的外伤性视神经损伤患者,MRI有利于病变的及早检出。

Objective To investigate HRCT and MRI manifestations of traumatic optic neuropathy.Methods HRCT and MRI findings of 19 patients with post-injury visual loss were retrospectively analyzed.Results ①HRCT was performed to all 19 patients.Optic canal fractures were found in 16 cases with 34 lesions,while no fracture was found in the other 3 cases.Fractures on medial and inferior wall of optic canal were common.The vicinal bone structure fractures of optic canal were found in all 19 cases with 77 lesions,including 23 lesions in orbital apex,15 lesions in greater wing of sphenoid bone near superior and inferior orbital fissure,11 lesions in sphenoidal planum near chiasmatic sulcus,2 lesions in lateral wall of sphenoid sinus and 26 lesions in anterior portion of orbit wall,sinusoidal walls of frontal and maxillary sinus.Large diameter of optic nerve was observed in 13 cases.②MRI was obtained in 10 of 19 patients.Abnormal high signal of optic nerve was found in 10 cases with 14 lesions,including 6 lesions in intra-orbital segment,5 lesions in intra-canal segment and 3 lesions in intracranial segment.③Optic canal decompression surgery was performed to all 19 patients.Improved eyesight of varied degrees was obtained in 13 of 19 cases within 7 days after surgery.Conclusion HRCT can provide detailed information of optic canal and its adjacent structures,while MRI has advantages in the visualization of optic nerve.MRI is helpful to detect the lesions promptly,particularly for traumatic optic neuropathy patients without optic canal fracture.