AIM： To investigate a possible correlation between visual acuity（VA） prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy（ITON）. M...AIM： To investigate a possible correlation between visual acuity（VA） prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy（ITON）. METHODS： From July 1 st, 2012 to July 1 st, 2015, 224 adults diagnosed with ITON who underwent endoscopic transethmosphenoid optic canal decompression（ETOCD） were reviewed. Visual outcome before and after treatment were taken into comparison. RESULTS： Accompanied older in age, longer time to medical treatment and existence of optic canal fracture（OCF） were the independent predictors for poor postoperative VA and lower improvement degree of visual acuity（IDVA）, while worse preoperative VA was predictive factor for poor postoperative VA only. Mean value of IDVA in patients with OCF was 0.19±0.30. Mean value of IDVA in patients without OCF was 0.29±0.35. IDVA in cases without OCF was significant higher than those with OCF（t=2.272, P〈0.05）. CONCLUSION： Patients suffered from ITON without OCF before ETOCD have better surgical outcome than those with OCF. Older in age, longer time to medical treatment and existence of OCF are independent factors for poor VA prognosis and lower IDVA. Preoperative VA is independent factor for VA prognosis only.展开更多
Objective To reconstruct the human optic canal and its inner structures, and to provide detailed knowledge of this region for optic nerve decompression for further understanding on the pathologic mechanisms of indire...Objective To reconstruct the human optic canal and its inner structures, and to provide detailed knowledge of this region for optic nerve decompression for further understanding on the pathologic mechanisms of indirect optic nerve injury Methods Six optic canals and their inner structures were reconstructed using a computer aided 3 dimensional reconstruction system Quantitative measurement of the canal wall thickness, bony canal transverse area, optic nerve transverse area, dural sheath transverse area, subarachnoid space transverse area, and subarachnoid space volume were done by means of the computer morphometric analysis system The detailed spatial relationship among intracanalicular structures were also carefully identified on the 3 D models Results The thinnest portion of the canal was the middle part of the medial wall (0 45±0 35?mm) and the narrowest space was in the middle part of the optic canal (the transverse area was 18 21±2 50?mm 2) The volume of subarachnoid space which can be considered the compensatory space for distention incurred by the hemorrhage, optic nerve edema, or hematoma was 21 16±4 31?mm 3 At the cranial opening ,the middle part and orbital opening, its transverse area was 4 45±1 12?mm 2, 2 68±1 32?mm 2 and 1 23±0 83?mm 2, respectively Conclusions Since the compensatory space was limited, even a tiny amount of blood or swelling of the nerve may cause optic nerve compression Because the narrowest space was in the middle part of the optic canal and the compensatory space for distention gradually decreases from cranial end to orbital end, the middle part and the anterior part of the optic canal and dural sheath are critical in optic nerve decompression展开更多
AIM: To investigate the efficacy and safety of the treatment of endoscopic trans-ethmosphenoid optic canal decompression(ETOCD) with combination of steroid in patients with newly onset indirect traumatic optic neuropa...AIM: To investigate the efficacy and safety of the treatment of endoscopic trans-ethmosphenoid optic canal decompression(ETOCD) with combination of steroid in patients with newly onset indirect traumatic optic neuropathy(ITON) and compare the outcome between immediate ETOCD treatment and ETOCD with preoperative steroid treatment. METHODS: Patients presented as newly onset ITON(suffered trauma within 3 d) at a tertiary medical center between Mar 1 st, 2016 and Mar 1 st, 2018 were enrolled in this study. All patients were equally and randomly divided into 2 groups. Cases in group A were performed ETOCD immediately after admition while cases in group B were prescribed by methylprednisolone(20 mg/kg · d) for 3 d before ETOCD. Methylprednisolone(20 mg/kg · d) was used after surgery for 6 d in group A and 3 d in group B. Follow-up was up to 3 mo in all cases. Visual acuity(VA) before and after treatment between the two groups were taken into comparison. RESULTS: Complete postoperative data were acquired from 34 patients in group A and from 32 patients in group B. Group A had significantly higher effective rate in VA than group B(χ~2 =4.905, P=0.027).CONCLUSION: For patients with newly onset ITON, combination treatment of ETOCD with high-dose steroid is an effective and safe way. Immediate surgery will lead to better prognosis for these cases.展开更多
基金Supported by the Natural Science Foundation of China(No.81371028)Natural Science Foundation of Zhejiang Province,China(No.LY12H12006)the Guided Innovation Project of the Eye Hospital of Wenzhou Medical University(No.YNCX201104)
文摘AIM： To investigate a possible correlation between visual acuity（VA） prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy（ITON）. METHODS： From July 1 st, 2012 to July 1 st, 2015, 224 adults diagnosed with ITON who underwent endoscopic transethmosphenoid optic canal decompression（ETOCD） were reviewed. Visual outcome before and after treatment were taken into comparison. RESULTS： Accompanied older in age, longer time to medical treatment and existence of optic canal fracture（OCF） were the independent predictors for poor postoperative VA and lower improvement degree of visual acuity（IDVA）, while worse preoperative VA was predictive factor for poor postoperative VA only. Mean value of IDVA in patients with OCF was 0.19±0.30. Mean value of IDVA in patients without OCF was 0.29±0.35. IDVA in cases without OCF was significant higher than those with OCF（t=2.272, P〈0.05）. CONCLUSION： Patients suffered from ITON without OCF before ETOCD have better surgical outcome than those with OCF. Older in age, longer time to medical treatment and existence of OCF are independent factors for poor VA prognosis and lower IDVA. Preoperative VA is independent factor for VA prognosis only.
基金ThisresearchwassupportedbyMilitaryMedicalandHygienic"95Project"ResearchGrantPLA China (No 96Z0 5 7)
文摘Objective To reconstruct the human optic canal and its inner structures, and to provide detailed knowledge of this region for optic nerve decompression for further understanding on the pathologic mechanisms of indirect optic nerve injury Methods Six optic canals and their inner structures were reconstructed using a computer aided 3 dimensional reconstruction system Quantitative measurement of the canal wall thickness, bony canal transverse area, optic nerve transverse area, dural sheath transverse area, subarachnoid space transverse area, and subarachnoid space volume were done by means of the computer morphometric analysis system The detailed spatial relationship among intracanalicular structures were also carefully identified on the 3 D models Results The thinnest portion of the canal was the middle part of the medial wall (0 45±0 35?mm) and the narrowest space was in the middle part of the optic canal (the transverse area was 18 21±2 50?mm 2) The volume of subarachnoid space which can be considered the compensatory space for distention incurred by the hemorrhage, optic nerve edema, or hematoma was 21 16±4 31?mm 3 At the cranial opening ,the middle part and orbital opening, its transverse area was 4 45±1 12?mm 2, 2 68±1 32?mm 2 and 1 23±0 83?mm 2, respectively Conclusions Since the compensatory space was limited, even a tiny amount of blood or swelling of the nerve may cause optic nerve compression Because the narrowest space was in the middle part of the optic canal and the compensatory space for distention gradually decreases from cranial end to orbital end, the middle part and the anterior part of the optic canal and dural sheath are critical in optic nerve decompression
基金Supported by the Natural Science Foundation of China(No.81371028)Natural Science Foundation of Zhejiang Province,China(No.LY12H12006)
文摘AIM: To investigate the efficacy and safety of the treatment of endoscopic trans-ethmosphenoid optic canal decompression(ETOCD) with combination of steroid in patients with newly onset indirect traumatic optic neuropathy(ITON) and compare the outcome between immediate ETOCD treatment and ETOCD with preoperative steroid treatment. METHODS: Patients presented as newly onset ITON(suffered trauma within 3 d) at a tertiary medical center between Mar 1 st, 2016 and Mar 1 st, 2018 were enrolled in this study. All patients were equally and randomly divided into 2 groups. Cases in group A were performed ETOCD immediately after admition while cases in group B were prescribed by methylprednisolone(20 mg/kg · d) for 3 d before ETOCD. Methylprednisolone(20 mg/kg · d) was used after surgery for 6 d in group A and 3 d in group B. Follow-up was up to 3 mo in all cases. Visual acuity(VA) before and after treatment between the two groups were taken into comparison. RESULTS: Complete postoperative data were acquired from 34 patients in group A and from 32 patients in group B. Group A had significantly higher effective rate in VA than group B(χ~2 =4.905, P=0.027).CONCLUSION: For patients with newly onset ITON, combination treatment of ETOCD with high-dose steroid is an effective and safe way. Immediate surgery will lead to better prognosis for these cases.
