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作者观察了外伤性视神经病变应用类固醇及外科手术治疗的患者23例,均用了大剂量类固醇(72小时内250mg 强的松龙)。用类固醇而未手术的16例,视力均有很大提高。静脉注射类固醇24至48小时后视力无提高者,若伴有球后视神经肿胀,(考虑为视神经鞘内出血)可采用球后视神经鞘减压术,若 CT 扫描证实有视神经管狭窄或有骨剌,则行视神经开窗术。3例视神经鞘减压术后,1例视力提高。4例采用视神经鞘减压术后和颅开窗术的视神经管外科减压术的联合手术,其中3例视力提高。两种手术均无并发症。在行视神经鞘减压术中,可见清亮的黄色液体从视神经鞘内流出,病例17未见到液体,其原因可能为:(1)视神经水肿不只限于蛛网膜下腔;(2)手术部位远离血液潴留处,但最终视力达20/25。核磁共振对局部积血的诊断有益。
The authors looked at 23 patients with traumatic optic neuropathy treated with steroids and surgically treated high-dose steroids (250 mg prednisolone in 72 hours). With steroids without surgery in 16 cases, visual acuity have greatly improved. Intravenous steroids 24 to 48 hours after visual acuity was not increased, if accompanied by retrobulbar optic nerve swelling, (consider the optic nerve intrathecal bleeding) can be retrobulbar nerve sheath decompression, if the CT scan confirmed the optic canal stenosis or bone spurs , The line of optic nerve fenestration. 3 cases of optic nerve sheath decompression, 1 case of visual acuity increased. Four patients underwent optic canal decompression combined with decompression of the optic nerve sheath and craniotomy underwent a combined surgery of the decompression of the optic canal, of which 3 cases had improved visual acuity. No complications of both operations. In the optic nerve sheath decompression surgery, we can see a clear yellow liquid out of the optic nerve sheath, the case did not see the liquid 17, the reasons may be: (1) optic nerve edema is not limited to the subarachnoid space; (2) the surgical site away from Blood retention, but the final visual acuity of 20/25. Nuclear magnetic resonance diagnosis of local blood is beneficial.