视神经鞘减压术对颅内静脉窦血栓形成后颅内高压患者视神经的保护作用

Protective effect of the optic nerve sheaths fenestration on optic nerve injury caused by intracranial hypertension in patients with cerebral venous sinus thrombosis

目的探讨视神经鞘减压术对颅内静脉窦血栓形成后颅内高压患者视神经损伤的保护作用。方法前瞻性纳入2007年6月—2010年12月颅内静脉窦血栓形成后颅内高压所致的视乳头水肿、视力下降、视野缺损的患者36例,经结膜入路实施视神经鞘减压手术治疗。比较术前、术后3、7、30、90、180、360 d的矫正视力、视野平均缺损值及视网膜神经纤维层厚度的变化,评价手术的有效性。观察围手术期患者颅内压变化和手术部位出血情况,评价手术的安全性。结果 36例患者的67只眼(双眼31例,单眼5例)接受手术治疗。发病至手术的时间为30～72 d,术前颅内压为(335±45)mmH2O;视力为0.40±0.24;视野平均缺损值为(-16±7)dB,视网膜神经纤维层厚度为(269±63)μm;所有患者手术7 d后视力和视野较术前改善,术后30 d颅内压降低,差异有统计学意义(均P<0.01),180 d时视力趋于稳定。患者均无围手术期颅内高压加重和眶后出血。结论视神经鞘减压术可改善颅内静脉窦血栓后颅内高压造成的视神经损伤患者的视力、视野及视乳头水肿,对视神经损伤具有保护作用。

Objective Study on the protective effects of the optic nerve sheaths fenestration on optic nerve injury caused by intracranial hypertension in patients with cerebral venous sinus thrombosis （CVST）. Methods Thirty six patients with papilledema,impaired vision, and visual field defect caused by CVST re-lated intracranial hypertension were underwent optic nerve sheaths fenestration via conjunctiva approach. The safety of operation was estimated by observing the status of local bleeding at the operative site and the changes of the intracranial pressure. The efficacy of the operation was evaluated by comparing the degree of the improvement of the operated eyes with themselves before operation on the items of the vision, the visual fields and the thickness of retinal nerve fibre layer at day-3,7,30,90,180 and 360 after operation Results A total of 67 eyes in consecutive 31 patients underwent the optic nerve sheaths fenestration operation at the days of 30-72 after onset of clinical symptoms ,from June 2007 to December 2010. The average intracranial pressure before operation was 335 ± 45 mm H2 O, visual acuity was 0.40 ± 0.24, visual field defect was -16 ± 7 dB, and the thickness of retinal nerve fiber layer was 269 ± 63 μm. No local bleeding and intracranial hypertension aggravation appeared in the cohort of patients during the preoperative period. All the items a-bove were improved remarkably at day-7 after operation（ all P 〈 0.01 ）. The visual acuity, visual field and thickness of retinal nerve fiber layer recovered after operation during 360 days of observation, the peak of the recovery appeared at about day-90 to day-180 after operation. Conclusion Optic nerve sheaths fenes- tration is an effective and safe method on saving the optic nerve injury caused by intracranial hypertension in patients with CVST.