Experience In The Treatment Of 70 Cases Of Traumatic Optic Neuropathy

Objective:Compare the effects of simple conservative treatment with transsphenoidal ethmoidal optic canal decompression under nasal endoscope and drug treatment on traumatic optic neuropathy,to discuss the therapeutic effect and related factors of transsphenoidal ethmoidal optic canal decompression under nasal endoscope on traumatic optic nerve injury.Methods:A retrospective analysis was made of 70 cases of traumatic optic nerve injury admitted to the neurosurgery department of our hospital from August 2016 to October 2018.Patients were divided into non-operative group and operative group according to whether or not they received transsphenoidal ethmoidal optic canal decompression under nasal endoscope.Non-surgical treatment group was given methylprednisolone 1.0g for three days plus 0.5g for two days,combined with anti-inflammatory,neurotrophic and microcirculatory drugs for 2-3 weeks.Operative group received transsphenoidal ethmoidal optic nerve decompression under nasal endoscopy within a limited period of time.Responsible fracture fragments were removed and full-thickness bone decompression was performed during the operation.Cranial orifice to orbital orifice of optic nerve canal and part of orbital apex wedge-shaped decompression were performed.The same medication scheme was given to non-operative group during the perioperative period.The improvement of final visual acuity level and visual field of patients three months after treatment were used as clinical evaluation.The data were analyzed by?~2test to evaluate the surgical efficacy and possible influencing factors.Results:Among 70 cases(74 eyes)with traumatic optic nerve injury,19 cases(22eyes)in the non-surgical treatment group,3 eyes were effective,the effective rate was13.6%;51 cases(52 eyes)in the surgical treatment group,35 eyes were effective,the effective rate was 67.3%.There was significant difference between the two groups(P<0.05).In the surgical treatment group,there were 7 eyes with preoperative photosensitivity and 4 eyes with effective rate of 57.1%.45 eyes without preoperative photosensitivity,and 31 eyes with effective rate of 68.9%.There was no significant difference in the effective rate between the two groups(P>0.05).27 eyes were operated on less than 72 hours after injury,20 eyes were effective,the effective rate was 57.1%.25 eyes were operated on more than 72 hours after injury,15 eyes were effective,the effective rate was 42.9%.There was no significant difference between the two groups(P>0.05).There were 41 eyes with definite optic canal fracture before treatment,29 eyes with effective rate of 72.7%,11 eyes without definite optic canal fracture after injury,and 6 eyes with effective rate of 54.5%.There was no significant difference in the effective rate between the two groups(P>0.05).Conclusion:ETOCD is an effective surgical method for TON,and has the advantages of minimally invasive,less invasive,sufficient exposure of surgical area and clear field.After the diagnosis of TON,no matter whether there is optic canal fracture or not,surgical treatment should be actively taken after the exclusion of contraindications.Surgical treatment is also effective for patients who have been injured for more than 72 hours and less than two weeks.