创伤性眶尖综合征的诊断与治疗进展

Progress in Diagnosis and Treatment of Traumatic Orbital Apex Syndrome

创伤性眶尖综合征是一种少见的颅脑创伤并发症,其主要特点是同时有眶上裂综合征和视神经损伤的表现。其临床症状多样,一般有眼肌麻痹、上睑下垂、瞳孔散大、视力减退等特点。诊断主要依靠临床表现和颅底CT三维重建等影像学检查。创伤性眶尖综合征目前有激素治疗和手术减压治疗等。基因治疗、神经干细胞移植在基础研究中取得了众多成果,但在临床应用上还有限制。手术减压目前认为是有效的,手术方式包括开颅手术和内镜手术,经鼻内镜手术减压具有微创、并发症少等优势。最佳的临床决策和手术治疗尚有待于多中心临床研究的开展和循证医学的支持。

Traumatic orbital apex syndrome is an uncommon complication of traumatic brain injury. The syndrome involves several pathological processes around the optic nerve foramen and the superior orbital fissure. It is characterized by optic neuropathy and ophthalmoplegia. The diagnosis relies mainly on clinical presentation and radiography such as skull base three-demensional reconstruction of CT. The current treatments of traumatic orbital apex syndrome include the use of steroid and surgical decompression.Gene therapy and transplantation of neural stem cells have made a series of achievements in experimental study, however the clinical applications are still restricted now. Decompression is considered as an effective management, and it contains nasal endoscopic approach and transcranial approach. Endoscopic approach is safe, effective, and offers marked advantages over traditional techniques. The optimal clinical strategy and surgical management need the research of evidence-based medicine and multi-center clinical trials.