经筛蝶视神经管减压术治疗外伤性视神经病变的疗效及影响因素分析

Analysis of therapeutic efficacy and influencing factors of transethmoidal-spheniodal optic nerve decompression for traumatic optic neuropathy

目的探讨经筛蝶入路视神经管减压术在外伤性视神经病变(TON)中的治疗效果及影响预后的因素。方法回顾性分析天津医科大学总医院神经外科自2008年1月至2019年12月收治的49例TON患者。通过术后视力恢复情况及相关并发症出现情况,对经筛蝶入路视神经管减压术的临床疗效进行评估,并分析影响预后的因素。结果49例患者均实施经筛蝶入路视神经管减压术,术后无严重并发症,总体有效率为53.1%。通过单因素分析发现,患者术前视力有无光反应、创伤至手术间隔时间与术后视力改善情况密切相关(P=0.011、0.016)。而患者年龄、意识状态、视神经管骨折程度、不同手术入路及是否伴有脑脊液漏与预后无明显相关性。结论TON患者通过经筛蝶入路行视神经管减压术,可改善伤后患者视力,并且对于术前有光感和创伤后尽早手术的患者,术后可能会取得更好的治疗效果。

Objective To investigate the therapeutic effect and prognostic factors of optic nerve decompression via ethmoid sphenoid approach in traumatic optic neuropathy(TON).Methods A total of 49 patients with TON in Neurosurgery Department of Tianjin Medical University General Hospital from January 2008 to December 2019 were retrospectively analyzed.Based on the postoperative visual acuity recovery and related complications,the clinical efficacy of ethmoid sphenoidal approach for optic nerve decompression was evaluated,and the factors affecting the prognosis were analyzed.Results All49 patients were treated with the decompression of optic nerve tube through sieve butterfly approach,and there’s no serious complications after surgery.The total effective rate was 53.1%.Through single factor analysis,it was found that optical preoperative visual response,trauma to surgical interval are closely related to postoperative vision improvement(P=0.011,0.016).The age,consciousness,degree of optic nerve canal fracture,different surgical approaches and CSF leakage were not significantly correlated with prognosis.Conclusion The visual acuity of patients with TON can be improved by optic nerve decompression through ethmoid sphenoidal approach,and the patients with preoperative light perception and early post-trauma surgery may obtain better treatment effect after operation.