Long-term Outcomes Following Endoscopic Transnasal Surgery for Optic Neuropathy Due to Craniofacial Fibrous Dysplasia
Long-term Outcomes Following Endoscopic Transnasal Surgery for Optic Neuropathy Due to Craniofacial Fibrous Dysplasia
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DOI：
10.1002/lary.30736
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发表时间：
2023-05-16
期刊：
影响因子：
2.6
通讯作者：
Wu，Wencan
中科院分区：
文献类型：
--
作者：
Wang，Min;Zhu，Senmiao;Wu，Wencan
目的探讨导航手术系统（NSS）引导下经鼻内镜视神经管减压术（ETOCD）治疗颅面纤维发育不良（CFD）所致压缩性视神经病变（CON）患者视力恢复的可行性，并探讨造成视力损害的根本原因。方法所有患者均行单侧NSS引导下的ETOCD，定期随访至少6个月。配对样本t检验和Pearson相关分析用于比较最终回顾时视觉结果的连续变量。术后对异常骨标本进行组织病理学检查。结果最终纳入34例患者，所有手术均顺利进行。最佳矫正视力（BCVA） （logMAR单位）由术前的1.29±0.80降至末次随访时的0.97±0.78 (p= 0.0012)，有28例（82.35%）患者改善。平均缺损（MD）绝对值显著降低（p< 0.001）。术前色觉受损17例，改善6例。末次随访时BCVA与术前BCVA、发病时间、术前视网膜神经纤维层厚度、MD呈显著相关（均p< 0.05）。在34例患者中，26例在视交叉前足附近有钝性骨突。73.53%的患者术后6个月或更早出现骨纤维复发，且无视力丧失。结论nss引导下的ETOCD对于CFD所致CON患者的视力恢复是安全有效的，早期手术干预对长期恢复至关重要。钝性骨突对视神经管的不平衡压迫可能是造成视力损害的主要原因。证据水平[j] .喉镜杂志，33 (3):1857 - 1866,2023
ObjectiveTo investigate the feasibility of endoscopic transnasal optic canal decompression (ETOCD) guided by a navigation surgical system (NSS) for vision recovery in patients with compressive optic neuropathy (CON) caused by craniofacial fibrous dysplasia (CFD), and to explore the underlying cause of visual impairment.MethodsAll patients underwent unilateral NSS‐guided ETOCD and were followed up periodically for at least six months. Paired sample t‐test and Pearson correlation analyses were used to compare continuous variables of the visual outcomes at the final review. A histopathological test of abnormal bone specimens was performed postoperatively.ResultsThirty‐four patients were finally included, and all surgeries were uneventful. The best corrected visual acuity (BCVA) (logMAR units) decreased from 1.29 ± 0.80 preoperatively to 0.97 ± 0.78 at the last follow‐up (p= 0.0012), improving in 28 patients (82.35%). The absolute value of mean defect (MD) significantly decreased (p< 0.001). Color vision was impaired in 17 patients preoperatively and improved in 6 patients. BCVA at the last follow‐up was significantly correlated with preoperative BCVA, onset time, preoperative retinal nerve fibril layer thickness, and MD (allp< 0.05). Among 34 patients, 26 had a blunt bony process near the anterior foot of the optic chiasm. Of the total patients, 73.53% patients experienced bony fiber recurrence 6 months or earlier after surgery without visual loss.ConclusionNSS‐guided ETOCD appeared to be safe and effective for visual recovery in patients with CON due to CFD, and early surgical intervention was critical for long‐term recovery. Unbalanced compression of the optic canal by the blunt bony process may be a major cause of visual impairment.Level of Evidence4Laryngoscope, 133:1857–1866, 2023