单侧视神经鞘开窗术治疗特发性颅内压增高的疗效分析  

Clinical effect of unilateral optic nerve sheath fenestration on visual outcomes of patients with idiopathic intracranial hypertension

作　　者：厉海英 张万宏 张圣旭 LI Hai-ying;ZHANG Wan-hong;ZHANG Sheng-xu(Department of Neurosurgery,Kaifeng Central Hospital,Kaifeng 475000,China)

机构地区：[1]开封市中心医院神经外科,河南475000

出　　处：《中国临床神经外科杂志》2022年第2期78-81,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨单侧视神经鞘开窗术(ONSF)治疗特发性颅内压增高(IIH)的临床疗效。方法回顾性分析2016年6月至2021年3月接受单侧ONSF治疗的10例IIH的临床资料。观察指标为术后1周、2周、1个月、3个月、6个月视力(VA)、平均视野偏差(PMD)、视神经乳头水肿等级、视神经乳头隆起(maxONHE)、黄斑区神经节细胞体积(GCLvol)。结果术后6个月,双侧VA、PMD、视神经乳头水肿等级和maxOHNE均明显改善(P<0.05),但两侧之间无统计学差异(P>0.05)。从诊断到手术时间与术后6个月PMD改善程度呈显著负相关(r=-0.783,P=0.0016)。基线颅内压与GCLvol变化呈明显负相关(r=-0.792,P=0.0011),与术后6个月PMD改善程度呈明显负相关(r=-0.519,P=0.041)。结论单侧ONSF是一种安全有效地治疗急性视力低下的IIH的方法,视神经乳头隆起及PMD是评估ONSF疗效的指标。Objective To investigate the clinical effect of unilateral optic nerve sheath fenestration(ONSF) on the visual outcomes of patients with idiopathic intracranial hypertension(IIH).Methods A retrospective analysis was performed on the clinical of 10 patients with IIH who underwent unilateral ONSF between June 2016 and March 2021.Main outcomes included visual acuity(VA),perimetric mean deviation(PMD),papilledema grade,maximum optic nerve head elevation(maxONHE) and volume of macular ganglion cell layer(GCLvol) 1 week,2 weeks,1 month,3 months and 6 months after the surgery.Results VA,PMD,papilledema grade,and maxOHNE were significantly improved 6 months after the operation on both the operated and non-operated eyes(P<0.05).The time from diagnosis to surgery was significantly negatively correlated with the extent of PMD improvement(r=-0.783,P=0.0016).The baseline intracranial pressure was significantly negtively correlated with the extent of volume channge of macular ganglion cells(r=-0.792,P=0.0011),and was significantly negatively correlated with the PMD value 6 months after surgery(r=-0.519,P=0.041).Conclusions The unilateral ONSF is a safe and effective treatment for the IIH patients with acute injured vision.The maxONHE and PMD are both viable biomarkers for assessing early treatment efficacy after ONSF.

关 键 词：特发性颅内压增高 视神经鞘开窗术 视神经乳头水肿 视野缺损 

分 类 号：R742[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]