Clinical Analysis Of Transnasal Optic Nerve Decompression Under Image Navigation

Objective:In this study,the best treatment and operation method for traumatic optic neuropathy were discussed by performing transnasal optic nerve decompression under image navigation.Through the analysis of different factors such as preoperative vision,trauma and operation time,the relevant factors affecting the surgical prognosis were summarized,so as to provide a basis and help for improving the clinical efficacy and prognosis of traumatic optic neuropathy.Methods:A retrospective analysis was performed on the complete clinical data of 35 patients(35 eyes)who underwent endoscopic nasal surgery for traumatic optic neuropathy(TON)from January 2015 to December 2018.According to the different surgical methods,the patients were divided into the guidance group(20 cases)and the non-guidance group(15cases).The guidance group(GG)received endoscopic nasal surgery under image navigation,while the non-guidance group(NGG)received traditional endoscopic optic nerve decompression.All the patients were treated with drugs for 3 days after admission.Patients with dullness or residual visual acuity who failed to respond to conservative treatment were treated with optic nerve decompression on the 4th day after admission.By comparing the operation time(AT),operation time(OT),bleeding amount(BA),intraoperative and postoperative complications of the two groups,the difference of operation methods between the two groups was evaluated.The patients were followed up for more than 3 months after the operation,and the final visual acuity in the last follow-up was taken as the final visual acuity.By comparing the differences of treatment effects under different factors in the two groups,the factors affecting the prognosis were summarized.Results:1.The anesthesia time,operation time and intraoperative blood loss of the guidance group were lower than that of the non-guidance group,with statistically significant differences(P < 0.05).2.The intraoperative and postoperative nasal and orbital complications in the guidance group were lower than those in the non-guidance group,with statistically significant differences(P < 0.05).3.Both the guidance group and the non-guidance group showed statistically significant differences between preoperative visual acuity and whether the VEP test could lead to P100 wave and the surgical prognosis(P < 0.05).There was no significant difference between the time from trauma to operation and the prognosis(P > 0.05).4.The total effective rate of the guidance group was 60%(12/20)higher than that of the non-guidance group 46.7%(7/15),with no statistically significant difference(P >0.05).Conclusion:Preoperative light sense and above,VEP examination can lead to P100 wave is a protective factor for vision improvement,th earlier the time from trauma to surgery,the better the prognosis of the patient,even if the best time for surgery is missed,still feasible surgical treatment.Transnasal optic nerve decompression under image navigation is an effective method for the treatment of traumatic optic neuropathy,which can achieve accurate positioning of optic nerve,shorten the time of surgery and anesthesia,reduce intraoperative blood loss,reduce intraoperative and postoperative complications,and achieve precision medicine,which is worth promoting.