视神经管减压术在颅眶骨纤维异常增生症中的应用

Evaluation of optic canal decompression in treatment of fibrous dysplasia of skull base

目的回顾性分析36例经颅显微视神经管减压术治疗因颅眶骨纤维增生症致视神经管狭窄和视力损害的患者的临床疗效。方法采用内分泌检查、眼科学检查以及影像学检查,对本组患者进行术前评估,手术采取经颅显微视神经管减压术。结果本组患者术后病理均为骨纤维异常增生症。本组患者均行三维螺旋CT骨窗位检查,21例单侧视神经管狭窄,15例双侧视神经管狭窄。18例行MR I检查,多数病变位于前中颅底,增强后呈中、轻度强化。本组患者均获得3个月至7年的有效随访,平均38个月。术后1周20侧(19例)术后视力较术前改善,21侧(15例)术后视力稳定在术前水平,2侧(2例)术后出现视力恶化。术前失明组均没有视力改善。术后长期随访(>1年)视力改善和稳定组中,分别有1例和3例出现视力恶化。结论经颅显微视神经管减压术对于治疗额-眶骨纤维增生症致视力障碍的患者中期治疗疗效满意。

Objective To retrospectively analyze the effect of optic canal decompression in 36 patients of fibrous dysplasia from August 1998 to August 2007.Methods Endocrine examination,ophthalmologic examination and computed tomographic（CT） examination were applied to evaluate the patients preoperatively.All the patients in this group received surgery of transcarnial optic canal decompression under microscope.Results The pathological diagnosis of each case was fibrous dysplasia.All the patients had CT scan and reconstruction in bone window.Twenty-one cases had unilateral optic canal stenosis,15 cases had bilateral optic canal stenosis.Eighteen cases had MRI,main part of lesion was in anterior and middle fossa,and slight or medium enhancing after injection of contrast medium.All the patients were followed up from 3 months to 7 years,38 months in average.Twenty sides（19 cases） had visual improvement 1 week after surgery,21 sides（15 cases） had no change in eye sight;2 sides（2 cases） had visual deterioration.One case had Rollet＇s Syndrome,1 case became blind after surgery.Cases who were blind before surgery had no improvement after the treatment.Follow-up after surgery（more than 1 year） in the improved group and stable group showed that 1 case and 3 cases respectively had visual deterioration.Conclusion Transcranial optic canal decompression showed more satisfactory effects in those who suffered visual acuity impairment caused by fibrous dysplasia in cranial-orbital area.