Optic Canal Decompression with a Lateral Approach for Optic Nerve Injury Associated with Traumatic Optic Canal Fracture
Optic Canal Decompression with a Lateral Approach for Optic Nerve Injury Associated with Traumatic Optic Canal Fracture
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DOI：
10.1097/gox.0000000000002489
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发表时间：
2019-10-01
影响因子：
1.5
通讯作者：
Ogawa, Rei
中科院分区：
文献类型：
--
作者：
Hokazono, Yu;Umezawa, Hiroki;Ogawa, Rei
视神经管骨折（OCF）是一种需要紧急干预的创伤性损伤，因为它可以导致视神经损伤和视力障碍。尽管OCF的严重性，但尚未建立标准的治疗方法。在这篇文章中，我们报告了一个病例，其合并外伤性视神经损伤，使用非传统的外侧入路松解视神经管，视力得以恢复。一位43岁男性，因右侧筛骨骨折、右侧眼眶爆裂性骨折及眶骨折就诊。术前视力为“手动”。损伤后10小时，通过从右耳前方的冠状切口侧向接近右侧视神经管，沿着蝶骨边缘切割，并刮除一些蝶骨翼和颧骨，进行减压。增加类固醇脉冲治疗。最终，视力提高到0.2，眼内压降低到16.0 mm Hg。与传统方法相比，该方法具有更好的安全性，因为（1）它引起的出血和脑脊液漏相对较少;（2）一旦确定蝶窦缝，到视神经管的距离相对较短;（3）如果骨折点位于视神经管外侧，可以直接观察骨折线。类固醇脉冲治疗也可能有助于良好的视力结果。这是第一份关于一种安全、有效且仅需要整形外科技能的新型外侧入路治疗OCF的报告。
Optic canal fracture (OCF) is a traumatic injury that requires urgent intervention because it can induce optic nerve damage and visual impairment. Despite the severity of OCF, a standard treatment method has not been established. In this article, we report a case of OCF and traumatic optic nerve injury in which visual acuity was recovered by releasing the optic canal using an unconventional lateral approach. A 43-year-old man presented with right lateral ethmoid fracture, right orbit blowout fracture, and OCF. The visual acuity was "hand motion" before surgery. Decompression was performed 10 hours after injury by approaching the right optic canal laterally from a coronal incision in front of the right ear, cutting along the border of the sphenoid bone, and scraping away some of the sphenoid wing and zygomatic bone. Steroid pulse therapy was added. Eventually, the visual acuity improved to 0.2 and the intraocular pressure decreased to 16.0 mm Hg. Compared with conventional methods, this method associates with better safety because (1) it causes relatively little bleeding and cerebrospinal fluid leak; (2) once the sphenozygomatic suture is identified, the distance to the optic canal is relatively short; and (3) if the fracture point is on the outer optic canal, the fracture line can be observed directly. Steroid pulse therapy may also have contributed to the good visual outcome. This is the first report of a novel lateral approach to OCF that is safe, effective, and only requires plastic surgery skills.