外伤性视神经病变的治疗进展

doi:10.3877/cma.j.issn.2095-123X.2023.06.009

外伤性视神经病变（TON）是颅颌面部外伤后严重视力丧失的重要原因，主要发生区域是视神经管及其前后端。TON的治疗方式目前主要有单纯观察、糖皮质激素治疗和视神经管减压手术，但关于治疗方式、治疗时机、手术入路的确定，目前尚无统一标准。但是无论是否使用糖皮质激素，视神经管减压术，特别是内镜经鼻-筛蝶视神经管减压术可使TON患者的视力显著提高。尽早手术和初始视力是影响手术治疗效果的重要因素。本文围绕TON的治疗进展进行综述。

关键词: 外伤性视神经病变, 内镜经鼻视神经管减压术, 手术时机, 糖皮质激素治疗

Traumatic optic neuropathy (TON) is a significant cause of severe visual loss after craniofacial trauma. The optic canal and its anterior and posterior ends are the main areas of TON. At present, the treatment of TON mainly includes simple observation, glucocorticoid therapy, and optic canal decompression surgery. However, there is currently no unified standard on how to choose the treatment method, grasp the timing of treatment, and which surgical approach to use. Research suggests that regardless of the use of glucocorticoids, optic canal decompression surgery, especially endoscopic transnasal transsphenoidal optical canal decompression, can significantly improve the visual acuity of TON patients. Early surgery and initial vision are important factors that affect the effectiveness of surgical treatment. This article reviews the treatment progress of TON.

Key words: Traumatic optic neuropathy, Endoscopic transnasal-transethmosphenoid optic canal decompression, Operation time, Glucocorticoid therapy

[1]	Pirouzmand F. Epidemiological trends of traumatic optic nerve injuries in the largest Canadian adult trauma center[J]. J Craniofac Surg, 2012, 23(2): 516-520. DOI: 10.1097/SCS.0b013e31824cd4a7.
[2]	Sosin M, De La Cruz C, Mundinger GS, et al. Treatment outcomes following traumatic optic neuropathy[J]. Plast Reconstr Surg, 2016, 137(1): 231-238. DOI: 10.1097/PRS.0000000000001907.
[3]	Yu-Wai-Man P. Traumatic optic neuropathy-clinical features and management issues[J]. Taiwan J Ophthalmol, 2015, 5(1): 3-8. DOI: 10.1016/j.tjo.2015.01.003.
[4]	Singh S, Sharma B, Kumar K, et al. Epidemiology, clinical profile and factors, predicting final visual outcome of pediatric ocular trauma in a tertiary eye care center of Central India[J]. Indian J Ophthalmol, 2017, 65(11): 1192-1197. DOI: 10.4103/ijo.IJO_375_17.
[5]	Bracken MB. Steroids for acute spinal cord injury[J]. Cochrane Database Syst Rev, 2012, 1(1): Cd001046. DOI: 10.1002/14651858.CD001046.pub2.
[6]	Yu-Wai-Man P, Griffiths PG. Steroids for traumatic optic neuropathy[J]. Cochrane Database Syst Rev, 2013, 2013(6): Cd006032. DOI: 10.1002/14651858.CD006032.pub4.
[7]	Stunkel L, Van Stavern GP. Steroid treatment of optic neuropathies[J]. Asia Pac J Ophthalmol (Phila), 2018, 7(4): 218-228. DOI: 10.22608/APO.2018127.
[8]	Mead B, Logan A, Berry M, et al. Intravitreally transplanted dental pulp stem cells promote neuroprotection and axon regeneration of retinal ganglion cells after optic nerve injury[J]. Invest Ophthalmol Vis Sci, 2013, 54(12): 7544-7556. DOI: 10.1167/iovs.13-13045.
[9]	Bacorn C, Morisada MV, Dedhia RD, et al. Traumatic optic neuropathy management: a survey assessment of current practice patterns[J]. J Emerg Trauma Shock, 2021, 14(3): 136-142. DOI: 10.4103/JETS.JETS_66_20.
[10]	Natarajan S, Baviskar PS, Gandevivala A, et al. Traumatic optic neuropathy in orbital wall fractures-diagnostic parameters and treatment outcomes: a prospective observational study[J]. J Stomatol Oral Maxillofac Surg, 2022, 123(2): 171-176. DOI: 10.1016/j.jormas.2021.06.010.
[11]	Kashkouli MB, Yousefi S, Nojomi M, et al. Traumatic optic neuropathy treatment trial (TONTT): open label, phase 3, multicenter, semi-experimental trial[J]. Graefes Arch Clin Exp Ophthalmol, 2018, 256(1): 209-218. DOI: 10.1007/s00417-017-3816-5.
[12]	Rashad MA, Abdel Latif AAM, Mostafa HA, et al. Visual-evoked-response-supported outcome of intravitreal erythropoietin in management of indirect traumatic optic neuropathy[J]. J Ophthalmol, 2018, 2018: 2750632. DOI: 10.1155/2018/2750632.
[13]	Wladis EJ, Aakalu VK, Sobel RK, et al. Interventions for indirect traumatic optic neuropathy: a report by the American academy of ophthalmology[J]. Ophthalmology, 2021, 128(6): 928-937. DOI: 10.1016/j.ophtha.2020.10.038.
[14]	Sung Y, Lee SM, Park M, et al. Treatment of traumatic optic neuropathy using human placenta-derived mesenchymal stem cells in Asian patients[J]. Regen Med, 2020, 15(10): 2163-2179. DOI: 10.2217/rme-2020-0044.
[15]	Li J, Bai X, Guan X, et al. Treatment of optic canal decompression combined with umbilical cord mesenchymal stem (stromal) cells for indirect traumatic optic neuropathy: a phase 1 clinical trial[J]. Ophthalmic Res, 2021, 64(3): 398-404. DOI: 10.1159/000512469.
[16]	Gupta D, Gadodia M. Transnasal endoscopic optic nerve decompression in post traumatic optic neuropathy[J]. Indian J Otolaryngol Head Neck Surg, 2018, 70(1): 49-52. DOI: 10.1007/s12070-017-1211-5.
[17]	Oh HJ, Yeo DG, Hwang SC. Surgical treatment for traumatic optic neuropathy[J]. Korean J Neurotrauma, 2018, 14(2): 55-60. DOI: 10.13004/kjnt.2018.14.2.55.
[18]	Wang X, Wu W, Zhang H, et al. Endoscopic optic nerve decompression through supraorbital keyhole extradural approach: a cadaveric study[J]. Turk Neurosurg, 2017, 27(2): 212-216. DOI: 10.5137/1019-5149.JTN.15298-15.1.
[19]	Di Somma A, Cavallo LM, de Notaris M, et al. Endoscopic endonasal medial-to-lateral and transorbital lateral-to-medial optic nerve decompression: an anatomical study with surgical implications[J]. J Neurosurg, 2017, 127(1): 199-208. DOI: 10.3171/2016.8.JNS16566.
[20]	Gao Y, Li J, Ma H, et al. The retinal vasculature pathophysiological changes in vision recovery after treatment for indirect traumatic optic neuropathy patients[J]. Graefes Arch Clin Exp Ophthalmol, 2021, 259(10): 3093-3105. DOI: 10.1007/s00417-021-05208-x.
[21]	Yu B, Chen Y, Ma Y, et al. Outcome of endoscopic trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy in children[J]. BMC Ophthalmol, 2018, 18(1): 152. DOI: 10.1186/s12886-018-0792-4.
[22]	Sun J, Cai X, Zou W, et al. Outcome of endoscopic optic nerve decompression for traumatic optic neuropathy[J]. Ann Otol Rhinol Laryngol, 2021, 130(1): 56-59. DOI: 10.1177/0003489420939594.
[23]	Martinez-Perez R, Albonette-Felicio T, Hardesty DA, et al. Outcome of the surgical decompression for traumatic optic neuropathy: a systematic review and meta-analysis[J]. Neurosurg Rev, 2021, 44(2): 633-641. DOI: 10.1007/s10143-020-01260-z.
[24]	Ma YJ, Yu B, Tu YH, et al. Prognostic factors of trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy[J]. Int J Ophthalmol, 2018, 11(7): 1222-1226. DOI: 10.18240/ijo.2018.07.24.
[25]	Zhao X, Jin M, Xie X, et al. Vision improvement in indirect traumatic optic neuropathy treated by endoscopic transnasal optic canal decompression[J]. Am J Otolaryngol, 2022, 43(3): 103453. DOI: 10.1016/j.amjoto.2022.103453.
[26]	Zhao SF, Yong L, Zhang JL, et al. Role of delayed wider endoscopic optic decompression for traumatic optic neuropathy: a single-center surgical experience[J]. Ann Transl Med, 2021, 9(2): 136. DOI: 10.21037/atm-20-7810.
[27]	Lin J, Hu W, Wu Q, et al. An evolving perspective of endoscopic transnasal optic canal decompression for traumatic optic neuropathy in clinic[J]. Neurosurg Rev, 2021, 44(1): 19-27. DOI: 10.1007/s10143-019-01208-y.
[28]	Lin J, Hu W, Wu Q, et al. Analysis of prognostic factors for the indirect traumatic optic neuropathy underwent endoscopic transnasal optic canal decompression[J]. J Craniofac Surg, 2020, 31(5): 1266-1269. DOI: 10.1097/SCS.0000000000006443.
[29]	Gao Y, Li J, Ma H, et al. Endoscopic trans-ethmosphenoid optic canal decompression is an optimal choice to save vision for indirect traumatic optic neuropathy[J]. Acta Ophthalmol, 2022, 100(2): e491-e501. DOI: 10.1111/aos.14951.
[30]	Yan W, Lin J, Hu W, et al. Combination analysis on the impact of the initial vision and surgical time for the prognosis of indirect traumatic optic neuropathy after endoscopic transnasal optic canal decompression[J]. Neurosurg Rev, 2021, 44(2): 945-952. DOI: 10.1007/s10143-020-01273-8.
[31]	Yu-Wai-Man P, Griffiths PG. Surgery for traumatic optic neuropathy[J]. Cochrane Database Syst Rev, 2013, 6(6): Cd005024. DOI: 10.1002/14651858.CD005024.pub3.
[32]	Boyack I, McPhee D, Rose Y, et al. Posttraumatic pneumatization of the optic sheath[J]. Am J Emerg Med, 2016, 34(9): 1911.e1913-1914. DOI: 10.1016/j.ajem.2016.01.018.
[33]	Cabrilo I, Dorward NL. Endoscopic endonasal intracanalicular optic nerve decompression: how I do it[J]. Acta Neurochir (Wien), 2020, 162(9): 2129-2134. DOI: 10.1007/s00701-020-04476-6.
[34]	Yu B, Ma YJ, Tu YH, et al. Newly onset indirect traumatic optic neuropathy-surgical treatment first versus steroid treatment first[J]. Int J Ophthalmol, 2020, 13(1): 124-128. DOI: 10.18240/ijo.2020.01.18.

[1]	郑智, 丁乙轩, 郭玉霖, 刘爽, 孙海晨, 曹锋, 李非. 早期和延迟腹腔镜胆囊切除术治疗轻度胆源性胰腺炎随机对照研究荟萃分析[J]. 中华普通外科学文献(电子版), 2021, 15(05): 395-400.
[2]	邹宏雷, 杨淑芬. 糖尿病合并急性胆囊炎手术时机的选择[J]. 中华普通外科学文献(电子版), 2020, 14(04): 276-279.
[3]	陈忠垚, 陈胜灯, 李秋. 不同手术时机对原发性肝癌自发破裂出血患者远期预后的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 518-521.
[4]	徐鹏, 谢东方, 袁琛, 于德洋, 李晨明. 手术时机对胆囊结石并重症急性胆源性胰腺炎二年随访结果的影响[J]. 中华普外科手术学杂志(电子版), 2020, 14(06): 593-596.
[5]	梅鑫, 张世科, 张巧珍, 吴文起. 前列腺增生导致下尿路症状手术时机的研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(01): 96-99.
[6]	董毅, 王林辉. 转移性肾癌减瘤性肾切除术的指征该如何把握[J]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(05): 289-292.
[7]	柴雅琴, 金发光, 郭晓雅, 张红军, 王瑞璇, 路玲, 顾兴. 特发性高嗜酸性粒细胞增多综合征伴多脏器受损一例病例报道[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 448-450.
[8]	吕垒, 冯啸, 何凯明, 曾凯宁, 杨卿, 吕海金, 易慧敏, 易述红, 杨扬, 傅斌生. 改良金氏评分在儿童肝豆状核变性急性肝衰竭肝移植手术时机评估中价值并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 661-668.
[9]	元云飞. 肝癌转化治疗后外科切除的必要性和手术时机[J]. 中华肝脏外科手术学电子杂志, 2023, 12(01): 11-15.
[10]	张宇鹏, 邓爱军, 孙艳. 促红细胞生成素治疗间接性外伤性视神经病变的应用进展[J]. 中华眼科医学杂志(电子版), 2023, 13(01): 45-49.
[11]	赵黎明, 王震宇, 万雨, 王银浩, 敖明昕, 李学民. 不同年龄患者选择白内障手术时机变化趋势的临床研究[J]. 中华眼科医学杂志(电子版), 2019, 09(03): 146-152.
[12]	李勇刚, 马峻, 雪亮, 苏少波, 张川, 曹艺耀, 赵子龙, 江荣才, 岳树源. 经筛蝶视神经管减压术治疗外伤性视神经病变的疗效及影响因素分析[J]. 中华神经创伤外科电子杂志, 2021, 07(03): 151-155.
[13]	杨利辉, 贾亚男, 闫建敏, 张颜礼, 高海晓, 冯国强. 3D-slicer辅助神经内镜治疗不同时期基底节区脑出血的研究[J]. 中华神经创伤外科电子杂志, 2020, 06(05): 275-278.
[14]	黄明火, 熊学辉, 魏小川, 罗杰. 动脉瘤破裂致蛛网膜下腔出血24 h内微弹簧圈栓塞干预的预后分析[J]. 中华神经创伤外科电子杂志, 2019, 05(03): 155-158.
[15]	漆祎鸣, 潘文志, 朱风琴, 周达新, 葛均波. 新型冠状病毒感染后经导管主动脉瓣置换术安全性分析[J]. 中华心脏与心律电子杂志, 2023, 11(02): 105-108.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Progress in treatment of traumatic optic neuropathy

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Progress in treatment of traumatic optic neuropathy