影像导航下经鼻内镜视神经减压治疗伴脑脊液鼻漏的创伤性视神经病

Application of image guidance system in endoscopic optic nerve decompression of traumatic occlusion optic neuropathy affiliated with cerebrospinal rhinorrhea

目的:探讨影像导航系统在伴有脑脊液鼻漏的创伤性视神经病患者手术治疗中的应用。方法:回顾性分析2006-06-2010-01期间收治的12例伴脑脊液鼻漏的创伤性视神经病患者,均在影像导航下经鼻内镜行视神经减压术,并同时行脑脊液鼻漏修补术。结果:随访3个月～1年,脑脊液鼻漏全部修补成功,患者视力恢复到0.3～0.6者1例,0.1～0.3者2例,0.1以下者1例,手动1例,恢复光感2例,总有效率为58.33%。结论:鼻内镜和影像导航系统的结合应用使手术视野开阔、定位精确并增加了安全性,尤其在局部解剖结构因外伤而导致毗邻关系改变的情况下,可有效减小创伤,提高安全性,是一种安全有效的治疗方法。

Objective：To investigate the advantages of image guidance system in endoscopic optic nerve decompression of traumatic occlusion optic neuropathy affiliated with cerebrospinal rhinorrhea.Method：Retrospective review of 15 traumatic occlusion optic neuropathy affiliated with cerebrospinal rhinorrhea at our department between June 2006 and June 2010.Witch were performed endoscopic optic nerve decompression and cerebrospinal rhinorrhea euplastic by image guidance system.Result：After 3 months to 1 year follow-up,All the cases with cerebrospinal rhinorrhea euplastic were successful.Two cases recovered to 0.3-0.6 in visual activity.Two cases to 0.1-0.3.One case was less than 0.1.Two cases could see hand movement and 2 cases had light perception.Total effective rate was 60 percent（9/15）.Conclusion：Image guidance system combined with endoscopy provides accurate localization and identifies the operative borders and critical anatomical structure of skull base,optic nerve and internal carotid artery,and also clearly indicate their adjacent relations,also decreases surgical invasions and complications.Image guidance system can improve the accuracy and safety,particularly in local anatomic structure due to the trauma caused by changes in the relationship.It is a safety and effective therapy method.