经颅视神经管减压术与药物综合治疗外伤性视神经损伤对照研究

目的对比经颅视神经管减压术与药物综合治疗外伤性视神经损伤的临床效果。方法选取我院2015-05—2016-05收治的32例外伤性视神经损伤患者为研究对象,随机分为对照组和观察组。对照组选用大剂量激素并进行综合治疗,观察组采用经颅视神经管减压术治疗。观察2组临床效果及并发症情况。结果观察组总有效率(87.50%)显著高于对照组(68.75%),差异有统计学意义(P0.05)。观察组并发症发生率6.25%,明显低于对照组的18.75%,差异有统计学意义(P0.05)。结论对外伤性视神经损伤患者采用经颅视神经管减压术治疗可起到明显效果,术后并发症较少,值得临床推广。     

视神经损伤经颅视神经管减压与视觉诱发电位的临床研究

目的探讨视神经损伤患者经颅视神经管减压治疗的临床疗效。方法回顾性分析经颅视神经管减压治疗的视神经损伤患者35例临床资料,3个月后复查视力及视觉诱发电位(VEP)检查。结果经颅神经管减压术后患者视力大部分改善;术前无光感患者术后视力恢复差;术后患者VEP的P100潜伏期延长、波幅降低,无光感患者波幅下降最明显。结论经颅神经管减压治疗有效,术前无光感患者手术效果差,术后VEP异常明显,VEP评价客观有效,与临床一致。     

经颅视神经管减压术(附4例报告)

作者采用翼点开颅视神经管减压术治疗视神经损伤 4例 ,疗效良好 ,现报告如下。一、对象与方法1.一般资料 :本组病例共 4例 ,其中男性 3例 ,女性 1例。年龄 13～ 5 5岁 ,平均 32 .5岁。车祸致伤 3例 ,摔伤 1例。伤后短暂意识丧失 2例 ,无昏迷史 2例。除患侧眼部症状外 ,均未见明显的其它神经定位体征。外伤后立即发现视力完全丧失 2例 ,立即呈现弱光感 1例 ,12h后渐进性视力减退至左眼颞侧和右眼全部无光感 1例。外伤至手术时间 6 .5h～ 5d,平均 2 .3d。2 .影像学表现 :4例影像检查结果分别为 :①CT示蛛网膜下腔少量出血、右颞叶挫裂伤、右…     

不同类型视神经损伤经颅手术治疗临床分析

目的评估不同类型视神经损伤病人经颅视神经减压术的疗效,探讨间接视神经损伤的发病机制与预后。方法回顾性分析163例病人的临床资料,尤其是受力部位和视神经管的CT特点,对间接视神经损伤进行分型,并在术后早期(2周)及中晚期(6￣72个月)对视力恢复进行评估。结果经χ2检验,术后2周与术后半年,眉弓外侧型疗效较眉弓内侧型和颧骨型差(P<0.001),而眉弓内侧型与颧骨型疗效无显著性差异(P>0.05)。结论经颅视神经减压手术是治疗间接视神经损伤的有效方法;眉弓内侧型和颧骨型视神经损伤手术效果优于眉弓外侧型。     

经颅视神经管减压术治疗外伤性视神经损伤

我科2001年6月至2003年4月共行经颅视神经管减压术16例,效果良好,现报道如下.     

经颅视神经管减压治疗视神经损伤

目的探讨视神经损伤的发生机理、分型及治疗方法。方法回顾性分析我院自1997年8月至2003年8月经颅视神经管减压治疗的21例视神经损伤病人的诊治过程及疗效。将伤后病人视力分为失明、光感、眼前手动、眼前指数和视力>0.05五个级别,术后上升一个级别评价为治疗有效。结果21例病人术后有效率为71.4%(15/21)。结论颅脑创伤合并视神经损伤经颅视神经管减压手术可获得较好疗效,原则上应尽早手术。     

经颅硬膜外入路视神经管减压术治疗外伤性视神经损伤

目的 探讨经颅硬膜外入路视神经管减压治疗外伤性视神经损伤12例（15侧）的经验。方法 额下入路8例，眶额入路3例，眶上锁孔入路1例。于额部硬膜外显露前颅底，全程减压视神经。结果 9例（12侧）术后1个月视力得到改善，无术后并发症。术前4例无光感，术后1月2例可见眼前手动。结论 经颅硬膜外入路视神经管减压术安全有效．药物治疗无效后应积极行视神经管减压术，该方法为外伤后失明患者的有效治疗方法。     

经颅视神经管减压开放术

目的报告１０例经颅视神经管减压开放术治疗视神经损伤。方法文章介绍了手术方法,比较１０例患者的受伤至手术时间、视神经管骨折、术中视神经的改变和术前、术后１月的视力变化,并结合文献探讨各种视神经管减压术及视神经损伤的机理。结果８例术后１个月视力得到改善,２例无效,１０例手术均无术后并发症。结论经颅视神经管减压开放术较其它类型减压术式,开放减压更为确切、彻底,且安全有效。     

经颅视神经管减压术治疗视神经损伤

目的探讨经翼点入路行视神经管减压术治疗外伤性视神经损伤的方法及临床疗效。方法对年月至年4月我们收治的6例外伤性视神经损伤患者经翼点入路行视神经管减压治疗。结果 4例术前视力呈眼前指动及以上者,术后分别随访3～23个月,均提升至0.4以上;2例术前失明患者,术后随访半年视力无改善。结论经翼点入路行视神经管减压术治疗外伤性视神经损伤可获得较好疗效。     

兔外伤性视神经损伤后不同时期减压的形态学观察

目的观察视神经损伤模型在损伤后不同时期减压的形态学改变,了解其与手术时机的关系。方法建立家兔外伤性视神经损伤模型,将损伤分为正常对照组、损伤48h减压组、7d减压组、14d减压组及损伤不减压组,在光镜下观察各组视神经的组织形态学改变。结果正常对照组视神经纵切面胶质细胞基本呈柱形均匀排列,神经纤维排列整齐。损伤48h减压组纵切面胶质细胞排列基本均匀,损伤处可见空泡样变性,可见少量胶质细胞增生。损伤7d减压组纵切面胶质细胞排列紊乱,大部分区域出现多个大小不等的空泡,部分区域出现脱髓鞘样变,胶质细胞增生明显。损伤14d减压组纵切面胶质细胞完全丧失柱形排列,胶质细胞明显增生,视神经脱髓鞘样变明显。损伤不减压组可见大片神经纤维坏死,视神经脱髓鞘样变明显,胶质细胞增生。结论神经元继发性损伤是视功能进行性下降的重要原因,视神经减压术有利于减轻视神经的间接损伤,较早期进行减压(48h)可阻止轴突继发性损伤。     

视神经损伤与经颅视神经管减压术

通过对近年来的19篇文献进行分析发现外伤性视神经经损伤主要发生在眉额部受到外力打击后,不一定伴有视神经管骨折,以伤后立即失明和伴有骨折者损伤较重,且疗效不理想。及时的颅视神经管减压是良好的选择,要求打开视神经管顶的全宽和全长,最好在伤后10天内尽早手术,早期大剂量的糖皮质激素的作用也日益受到关注。对于视神经管段的视神经损伤,经颅视神经管减压术是值得大力提倡的。     

外伤性视神经病变临床救治的初步观察

目的 探讨大剂量甲基强地松龙冲击疗法和联合视神经骨管减压治疗外伤性视神经病变的疗效和时机。方法外伤性视神经病变21例(21眼),甲基强地松龙(10-30 mg/kg)加入5％葡萄糖溶液500 ml静脉滴注3-5 d,l/d。其中,2例存窥镜下经鼻窦行视神经骨管减压+视神经鞘膜切开,1例开颅行视神经骨管减压+视神经鞘膜切开。结果视力提高≥0.1,7例;视力提高<0.1或仅视野扩大,5例;视力无进步,9例;总有效率57.1％。伤后1周内就诊,有效率75％;1-2周就诊,有效率55.6％;2周以后就诊,有效率16.7％。结论视神经受损的严重程度和救治是否及时决定着伤眼的视力预后,大剂量甲基强地松龙冲击治疗是一种安全有效的救治视神经损伤的方法,联合视神经管减压手术是否效果更好尚有待观察。     

大鼠视神经损伤定量模型的建立

目的建立标准化视神经损伤大鼠动物模型，对致伤强度、损伤程度及两者之间的关系进行量化分析。方法在立体定位下，利用微电极毁损视神经颅内段，毁损电压为5V，频率为60kHz，通过改变电毁损的电流强度，造成不同程度视神经损伤。然后进行视网膜切片，计数视神经节细胞层细胞，定量视神经损伤。结果析因方差分析结果显示：视神经节细胞计数存不同刺激时间之间，差异硅著（F=3472，14，P〈0．001）；在不同电流强度组间，差异显著（F=335．83，P〈0．001）；经LSD法多重比较，视神经节细胞计数在刺激电流之间及刺激时间之间差异在α=0．05水平均有显著性意义。刺激强度和刺激时间的单独效应：同一电流组随着刺激时间增加．视神经节细胞计数呈下降趋势；除对照组和90s组外（F=0．79，P=0．548；F=1．54，P=0．242），刺激时间相同时，随电流强度增加．细胞计数也呈下降趋势，刺激电流强度与刺激时间之间交互效廊显著（F=27．30，P〈0．001）：结论立体定向电毁损大鼠颅内段视神经模型可以测定致伤强度和视神经损伤程度，是较理想的视神经损伤模型。     

视神经管减压术治疗视神经损伤的疗效分析(附23例报告)

目的探讨经颅硬膜外视神经管减压术治疗视神经损伤所致失明的效果。方法回顾性分析自2003年1月至2010年8月手术治疗的视神经损伤所致完全失明23例患者的临床资料,比较视神经管减压术前后视力的变化;以伤后6个月视力为最终视力,分析23例患者手术疗效。结果术中发现6例有视神经管骨折,1例有骨折片;1例有鞘膜内血肿。本组无手术并发症发生。23例患者术后随访6月,有效6例(26.1%),无效17例(73.9%);其中伤后5d内手术15例中,有效6例(40.0%),无效9例(60.0%);5d后行手术者8例均无效;5d内手术者有效率明显高于5d后手术者(P<0.05)。结论早期行经颅硬膜外视神经管减压术可使部分视神经损伤所致失明患者的视力得到改善。     

经颅入路手术治疗创伤性视神经损伤

目的探讨颅脑创伤合并视神经损伤的治疗方法.方法经手术治疗20例颅脑创伤合并视神经损伤患者,17例经额下入路行额冠状皮瓣一侧额部开颅;3例眶上裂综合征患者行额颞切口,经眶尖外侧壁入路.评价手术后视力恢复的标准为黑朦、光感、眼前手动、眼前数指和能见标字视力表符号5个级别.术后视力提高2个级别以上者为有效,否则为无效.结果手术后65%(13例)的患者达到有效,其中3例眼球突出、1例眼球内陷患者术后均得到矫正.结论颅脑创伤合并视神经损伤患者,经额部或额颞入路手术行视神经减压,可取得良好效果.术后视力恢复与损伤后手术时间、手术方法相关,亦与视神经损伤程度有密切关系.     

创伤性视神经损伤预后影响因素分析及视神经管骨折手术策略选择

目的探讨视神经管减压术治疗创伤性视神经损伤（TON）的疗效,评估相关预后影响因素,并分析视神经管不同部位骨折手术策略选择。 方法回顾性分析空军军医大学第二附属医院神经外科自2011年1月至2020年6月收治的58例TON后行视神经减压术患者的临床资料,采用单因素和多因素Logistic回归分析评价预后的潜在影响因素。根据视神经管骨折位置的不同,选择开颅视神经减压术和经鼻内镜减压术评估不同术式对不同骨折位置患者的术后视力改善情况的影响。 结果58例TON患者均行视神经减压术,33例患者术后视力得到改善（改善组）,其中9例行开颅视神经管减压术,24例行经鼻内镜减压术;25例患者术后视力未得到改善（未改善组）,其中8例行开颅视神经管减压术,17例行经鼻内镜减压术。单因素和多因素Logistic回归分析确定术前视力及视神经管是否骨折是术后视力改善的独立影响因素,有光感者有效率明显高于无光感者,无视神经管骨折患者术后改善率明显高于有视神经管骨折患者。35例单发视神经管骨折患者中,视神经管内下壁骨折使用经鼻内镜视神经减压有更好的预后,开颅减压则对于外上壁骨折更有益。 结论视神经管减压术治疗TON总体有较好的效果,尤其是对于术前尚存光感的患者。对于视神经管骨折患者应根据骨折位置选择合理的手术方式进行视神经减压。     

Neuronal apoptosis and neurofilament protein expression in the lateral geniculate body of cats following acute optic nerve injuries

BACKGROUND: The visual pathway have 6 parts, involving optic nerve, optic chiasm, optic tract, lateral geniculate body, optic radiation and cortical striatum area. Corresponding changes may be found in these 6 parts following optic nerve injury. At present, studies mainly focus on optic nerve and retina, but studies on lateral geniculate body are few. OBJECTIVE: To prepare models of acute optic nerve injury for observing the changes of neurons in lateral geniculate body, expression of neurofilament protein at different time after injury and cell apoptosis under the optical microscope, and for investigating the changes of neurons in lateral geniculate body following acute optic nerve injury. DESIGN: Completely randomized grouping design, controlled animal experiment. SETTING: Department of Neurosurgery, General Hospital of Ji’nan Military Area Command of Chinese PLA. MATERIALS: Twenty-eight adult healthy cats of either gender and common grade, weighing from 2.0 to 3.5 kg, were provided by the Animal Experimental Center of Fudan University. The involved cats were divided into 2 groups according to table of random digit: normal control group (n =3) and model group (n = 25). Injury 6 hours, 1, 3, 7 and 14 days five time points were set in model group for later observation, 5 cats at each time point. TUNEL kit （Bohringer-Mannheim company）and NF200& Mr 68 000 mouse monoclonal antibody （NeoMarkers Company）were used in this experiment. METHODS: This experiment was carried out in the Department of Neurosurgery, General Hospital of Ji’nan Military Area Command of Chinese PLA between June 2004 and June 2005. ① The cats of model group were developed into cat models of acute intracranial optic nerve injury as follows: The anesthetized cats were placed in lateral position. By imitating operation to human, pterion approach was used. An incision was made at the joint line between outer canthus and tragus, and deepened along cranial base until white optic nerve via optic nerve pore and further to brain tissue. Optic nerve about 3 mm was liberated and occluded by noninvasive vascular clamp for 20 s. After removal of noninvasive vascular clamp, the area compressed by optic nerve was hollowed and narrowed, but non-fractured. Skull was closed when haemorrhage was not found. Bilateral pupillary size, direct and indirect light reflect were observed. Operative side pupil was enlarged as compared with opposite side, direct light reflect disappeared and indirect light reflect existed, which indicated that the models were successful. Animals of control group were not modeled .② The animals in the control group and model group were sacrificed before and 6 hours, 1, 3, 7 and 14 days after modeling respectively. Lateral geniculate body sample was taken and performed haematoxylin & eosin staining. Immunohistochemical staining showed lateral geniculate body neurofilament protein expression, and a comparison of immunohistochemial staining results was made between experimental group and control group. Terminal deoxynucleo-tidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) was used to label apoptotic cells in lateral geniculate body. MAIN OUTCOME MEASURES: Neuronal morphological change, neurofilament protein expression and cell apoptosis in lateral geniculate body following acute optic nerve injury. RESULTS: Twenty-eight involved cats entered the final analysis. ① Histological observation results: In the control group, cell processes were obviously found, which were few or shortening in the model group. ② Neuronal neurofilament protein expression: Cells in lateral geniculate body in the control group and at 6 hours after injury presented clear strip-shaped staining, and those at 7 and 14 days presented irregular distribution without layers and obviously decreasing staining intensity. The positive rate of neurofilament protein in lateral geniculate body in control group and 6 hours, 1, 3, 7 and 14 days after injury was （10.22±0.42）%，（10.03±0.24）%，（9.94±0.14）%，（9.98±0.22）%，（8.18±0.34）% and (6.37±0.18)%, respectively. Positive rate of neurofilament protein in control group, at 6 hours, 1 or 3 days after injury was significantly different from that at 7 days after injury (P < 0.05); Positive rate of neurofilament protein in control group, at 6 hours, 1, 3 or 7 days after injury was significantly different from that at 14 days after injury (P < 0.05). It indicated that neuronal injury in lateral geniculate body was not obvious within short term after optic nerve injury, but obvious at 7 days after injury and progressively aggravated until at 14 days after injury. ③ Neuronal apoptosis: TUNEL staining showed that neuronal apoptosis in lateral geniculate body appeared at 7 days after injury, and a lot of neuronal apoptosis in lateral geniculate body was found at 14 days after injury. It indicated that neuronal injury in lateral geniculate body was related to apoptosis. CONCLUSION: In short term after optic nerve injury (within 7 days), nerve injury of lateral geniculate body is not obvious, then, it will aggravate with the elongation of injury time. The occurrence of neuronal injury of lateral geniculate body is related to the apoptosis of nerve cells.