脑脊液动力学与视神经损伤疾病病理生理机制的关系  

Relationship between cerebrospinal fluid dynamics and pathophysiological mechanisms of optic nerve damage diseases

作　　者：傅楹迪 谢媛[1] 王宁利[1] Fu Yingdi;Xie Yuan;Wang Ningli(Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院、北京同仁眼科中心、北京市眼科研究所、眼科学与视觉科学北京市重点实验室,北京100730

出　　处：《国际眼科纵览》2023年第5期392-399,共8页International Review of Ophthalmology

基　　金：国家科技重大专项(HYZHXM01014);国家自然科学基金重点项目(82130029)。

摘　　要：近年来不断有研究提出,脑脊液动力学受损是引起视神经功能损伤相关疾病的共同病理生理机制。对脑脊液动力学,尤其是视神经蛛网膜下腔(optic nerve subarachnoid space,ONSAS)脑脊液动力学的进一步研究,可能有助于理解诸如特发性颅高压、航天飞行相关的神经-眼综合征、正常眼压性青光眼等导致视神经损伤、视力障碍疾病的发病机制,为其防治提供更多的思路。受到视神经管狭窄程度、眼压及解剖结构变异等因素的影响,颅内的脑脊液可能无法流入ONSAS,而ONSAS内的脑脊液也有可能逆流入颅内。ONSAS脑脊液压力的改变是引起视盘水肿和视盘萎缩的主要因素,压力变化及炎症等因素刺激ONSAS内的脑膜上皮细胞增生,使腔内空间变小,导致视神经鞘腔室综合征,使脑脊液动力学受损,进一步导致视神经损伤。目前尚无评估ONSAS脑脊液压力的金标准和实时监测脑脊液动力学的手段,仅能通过视神经鞘直径或颅内压的变化来粗略判断ONSAS脑脊液压力的变化。In recent years,it has been proposed that the impairment of cerebrospinal fluid(CSF)dynamics is the common pathophysiological mechanism causing diseases associated with optic nerve impairment.Further study of CSF dynamics,especially optic nerve subarachnoid space(ONSAS)cerebrospinal fluid dynamics,may contribute to the understanding of conditions such as idiopathic intracranial hypertension,spaceflight-associated neuro-ophthalmic syndrome,normal-tension glaucoma and other diseases that cause optic nerve damage and visual impairment,and provide more ideas for their prevention and treatment.The CSF may not flow into ONSAS because of the degree of optic canal stenosis,intraocular pressure and the variation of anatomic structure.The change of ONSAS cerebrospinal fluid pressure is the main factor that cause optic disc edema and atrophy.The changes of pressure and inflammation stimulate the proliferation of meningeal epithelial cells in ONSAS and make the space of lumen become smaller,it leads to the occurrence of optic nerve sheath compartment syndrome,which damages the CSF dynamics and further leads to optic nerve injury.At present,there is no gold standard for evaluating CSF pressure in ONSAS and means to monitor CSF dynamics in real time.The change of CSF pressure in ONSAS can only be roughly judged by the change of optic nerve sheath diameter or intracranial pressure.

关 键 词：脑脊液动力学 视神经蛛网膜下腔脑脊液压力 视神经鞘 视神经损伤 

分 类 号：R774.6[医药卫生—眼科]