神经内镜下经筛蝶行视神经减压治疗创伤性视神经损伤的疗效及其预后的影响因素分析

Clinical effect and prognostic factors of transethmosphenoidal optic nerve decompression in treatment of traumatic optic neuropathy under neuroendoscope

目的观察神经内镜下经筛蝶行视神经减压治疗创伤性视神经损伤(TON)的疗效,以及分析预后的影响因素。方法回顾性分析该院2017年1月-2020年1月收治的21例24眼TON患者的临床资料,所有患眼均经筛蝶行视神经减压术。比较分析术后视力改善状况,以评估手术疗效,并对预后的影响因素进行分析。结果术后未发生严重不良事件,有效率为54.17%。经单因素分析发现,术前视力是否存在光感和实施手术的及时性是影响预后的因素(P=0.002,P=0.013)。而年龄、视神经管骨折、意识状况、创伤类型、手术路径和是否存在脑脊液漏均与预后无明显相关性。结论神经内镜下经筛蝶行视神经管减压术是治疗TON的有效手段,实施手术的及时性和术前是否存在光感是预后的影响因素。

Objective To observe the efficacy and interference with the visual prognosis closely linked elements of neuroendoscopic transethmosphenoidal route for optic nerve decompression for traumatic optic neuropothy(TON).Methods Clinical data of 21 patients with 24 eyes TON from January 2017 to January 2020 were retrospectively analyzed,and all the affected eyes underwent optic nerve decompression using a transethmosphenoidal route.The status of postoperative visual improvement was comparatively analyzed to judge the efficacy of surgery,and factors that interfered with the prognosis of visual acuity were traced and explored.Results No serious adverse events occurred after surgery,with a response rate of 54.17%.After univariate analysis,whether there was light perception in preoperative visual acuity and timeliness of implementing surgery were closely related to the effective improvement of postoperative visual prognosis(P=0.002,P=0.013).Age,status of consciousness,optic tract fracture,surgical route,and the presence or absence of cerebrospinal fluid leakage were not significantly associated with visual prognosis.Conclusion Neuroendoscopic transethmosphenoidal optic nerve decompression can safely and effectively treat TON,and the presence or absence of light perception preoperatively and the timeliness of implementing the surgery are closely linked elements in the prognosis of diseased eye vision,which may lead to better postoperative outcomes in patients with light perception preoperatively and in the early posttraumatic period.