经颅视神经减压开放术治疗外伤后迟发失明

Surgical treatment of traumatic delayed blindness by subfrontal approach

目的 :报告 2 0例经颅视神经减压开放术治疗外伤后迟发失明。方法 :经冠状切口额部开颅硬膜下入路 ,视神经管上壁骨性减压 ,并剪开视神经鞘膜。评价手术后视力恢复的标准为 :失明、眼前手动、眼前数指、光感、能见视力表符号 5个级别。术后视力提高 1个级别以上者为有效 ,否则为无效。结果 :2 0例患者共 9例术后恢复了视力 ,有效率为 45 %。结论 :迟发性失明的患者应行急诊手术治疗 ,术后视力恢复与损伤后至手术时间、手术方法相关 。

Objective:Twenty cases of traumatic delayed blindness by treatment of transfrontal decompression of optic nerve were reported.Methods:Transfrontal craniotomy,bony optic canal decompress and opening optic sheath were performed.For the purpose of evaluation,the postoperative outcome of visual acuity was classified into five grades:blindness,hand motion,finger counter,light perception,and acuity chart vision.The visual acuity improvement reaching one grade or more was defined as effective,and less than one grade as inefficient.Result:All patients were followed up from 1 month to 6 months.9 patients had effective in visual acuity recovery.Conclusion:Patients with traumatic delayed blindness should receive emergency operation.The visual acuity recovery is correlated with the timing of surgery,operative approach and the severity of optic nerve injury.