Clinical Diagnosis And Treatment Of Traumatic Optic Neuropathy Re-examine The Progress

Purpose and background:With the increase in traffic accidents and fall injury incidence of closed head injury also show an increasing trend year by year. Of which were associated with optic nerve injury 0.7% ~ 5.0%【1,2】.Traumatic optic nerve injury clinically known as traumatic optic neuropathy,TON.It is the relatively rare but more serious complication of brain injury,known as a true eye emergency.The National Acute Spinal Cord Injury Study 2 (NASCIS 2)established the current treatment protocol for the management of TON, which indicates that treatment should start within 8 h of injury. But often because the doctor in charge of a lack of understanding of the disease,Effort to dispose of traumatic brain injury and ignore the existence of this disease.Resulted the disease can not be in the timely diagnosis and treatment .This study by cases of traumatic optic neuropathy in patients with clinical diagnosis, treatment and prognosis, and by conduct an extensive literature review, summarizes the current progress of clinical diagnosis and treatment of the disease. Aims to provide general medical practitioners able to closed head injury associated with the disease in patients with attention, and can give a reasonable and timely disposal of sync. Enhance the cure rate of the disease , improve the quality of life in patients after injury. For the TON and regeneration mechanism of the injury mechanism has not been fully clarified. More scholars will be divided into direct and indirect optic nerve injury, the latter were more common. And has a better prognosis. The former is mostly from the physical injury. Fracture film stabbed, optic nerve shock. While the latter are mostly vascular changes , thrombosis and vascular spasm caused by ischemic changes in the main. For the optic nerve regeneration is currently experimental research stage ,there is no clear clinical reports.Current diagnosis of the disease basically reached a consensus at home and abroad. Through a typical orbital trauma, vision test, typical pupil, nervous system imaging, flash visual evoked potential (FVEP) , can be diagnosed.With the simultaneous development of clinical multi-disciplinary, the treatment of the disease often involves the Ophthalmology , ENT, neurosurgery and so on together or independently at home and abroad . Simple medication, the impact of high-dose hormone therapy, drug treatment and other supplementary neurotrophic , has been recognized as traumatic optic nerve injury in first-line therapy. Since 1911 Kronlein carried out optic nerve decompression surgery. A variety of surgical approaches to optic nerve decompression has been widely used in the treatment of clinical optic nerve injury. The 20th century, 60 years. With the neurosurgery microscopy techniques and skull base surgery development. The transcranial optic nerve decompression surgery has gradually become a necessary means of optic nerve injury. Current treatment of traumatic optic nerve injury, optic nerve decompression at the same time to be drug-assisted therapy has gradually been recognized foreign scholars. and to obtain a more clear-cut effect. At present a variety of surgical decompression of the optic nerve into the path of the advantages and disadvantages have been more reports. But transcranial optic nerve decompression skills in less reporting , here we have six cases of surgical decompression in the process of the experience, for reference.The timing of surgery for the disease , has become a hot topic in the current study. There is no unified opinion. At home and abroad for the majority of scholars believe that the vision gradually decreased after injury, and clearly the existence of optic canal fracture and those who hematoma , early surgical intervention as far as possible. To remove the hematoma , chip fracture. Full decompression has better effect. Is generally believed that the surgery for 1 week were more positive effect, 48h in the surgery in order to best effect . More than 1 week after injury , even a few months, also reported that a small amount of cases restore some vision surgery.As the optic nerve and optic canal anatomy research , Optic nerve decompression principle raised many questions. Since 1981 the principle of optic nerve decompression was raised by the Sofferman , been adopted by the majority of clinicians use. The beginning of this century, as people come to realize this disease and research, Many scholars perfect and Correction the original principles more or less . Unfortunately, So far still no decompression of the principle of authority was proposed.Materials and Methods: We have summarized the past year and a half time, our section 6 cases of traumatic optic nerve injury, which 4 men and 2 women ,aged 19-36 years old, are the height of a car accident or a fall injury, the time after injury and admission to hospital around 1h ~ 7d, were accompanied by transient disturbance of consciousness, orbital exist in the amount of skin bruising, occur immediately after injury or delayed vision loss or reduce . Typical Gunn phenomenon . Including four cases of varying degrees of vision loss and eye movement disorders. Imaging studies of 5 cases of optic canal fracture of the existence tips. Due to lack of equipment, can not FVEP Inspection. Apart from 2 patients can not early detection optic nerve injury, failed at an early stage of high-dose steroid pulse therapy. The remaining four cases were given within 8h after injury, the impact of high-dose hormone therapy. And were carried out surgery within 1d-1w after injury. Postoperative adjuvant therapy is still given medicines. And conduct 2 month to 23 month of follow-up . 4 cases in which preoperative visual acuity of patients surviving , postoperative visual acuity significantly. 2 cases of blindness in patients with preoperative still no light perception .Conclusion:1. Optic canal decompression in the treatment of drug supplemented, precise than a simple drug treatment efficacy. The optic nerve transection were both taken to the treatment ineffective. Prognosis and the degree of damage.2. Transcranial optic nerve decompression broad field of vision, can Ophthalmic artery exploration. And sheath decompression. Aim to achieve full decompression.More safe. Can be dealt with intracranial hematoma, and cerebrospinal fluid rhinorrhea.3. Because the case is less,timing of surgery, medicine and surgery controlled study issues such as failure to form a regression analysis. Hope to be able to carry out more large-scale deeper exploration.