外傷性視神経損傷に対する経上眼窩裂硬膜外視神経管開放術の有用性

抄録

A total of 8 consecutive patients with traumatic optic neuro­pathy (TON) underwent extradural optic canal de­compression via the trans-superior orbital fissure (SOF) approach between September 2009 and August 2014. We retrospectively review medical charts, radiological findings, surgical techniques, complications, and final surgical results. All 8 patients presented with visual disturbance caused by head and/or face injury. Two patients had no light perception, 6 had light perception, and 2 had ophthalmoplegia. All patients underwent extradural optic canal decompression and high-dose steroid administration within 24 hours after injury. Postoperative visual acuity on discharge was im­proved in 6 patients and unchanged in 2 patients with ophthalmoplegia gradually recovered by 3 months after injury. Postoperative outcome was good recovery in 7 patients and moderate disability in one patient. There were no complications related to the surgical procedure. The advantage of this surgical procedure is easy identification of the optic canal, resulting in fewer surgical complications, and this procedure can also achieve intraorbital decompression. We recommend extradural optic canal decompression via the trans-SOF approach as a safe and reliable procedure in patients with TON.