神经内镜经鼻入路减压术治疗外伤性动眼神经麻痹的疗效观察  

Observation on the efficacy of neuroendoscopic transnasal decompression in the treatment of traumatic oculomotor nerve palsy

作　　者：王安琪 孙飞 刘华 蒋栋毅[1] 王之敏[3] 沈李奎[1] Wang Anqi;Sun Fei;Liu Hua;Jiang Dongyi;Wang Zhimin;Shen Likui(Department of Neurosurgery,Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine,Suzhou 215028,China;Department of Neurosurgery,the First People′s Hospital of Kunshan,Kunshan 215300,China;Department of Neurosurgery,Affiliated Dushu Lake Hospital of Soochow University,Suzhou 215127,China)

机构地区：[1]上海交通大学医学院苏州九龙医院神经外科,苏州215028 [2]昆山市第一人民医院神经外科,昆山215300 [3]苏州大学附属独墅湖医院神经外科,苏州215127

出　　处：《中华神经外科杂志》2023年第12期1235-1239,共5页Chinese Journal of Neurosurgery

基　　金：苏州市科技发展计划(SKYD2023031)。

摘　　要：目的初步观察神经内镜经鼻入路减压术治疗外伤性动眼神经麻痹的疗效。方法回顾性分析2016年1月至2022年1月上海交通大学医学院苏州九龙医院神经外科采用神经内镜经鼻入路减压术治疗的4例外伤性动眼神经麻痹患者的临床资料。采用眶尖、眶上裂、视神经管、视柱依次减压的手术策略。术后复查三维CT明确减压程度和范围,随访动眼神经麻痹症状的改善情况。结果4例患者均成功手术,术中及术后影像学证实眶上裂内侧缘减压充分。患者均无手术相关并发症。术后1年随访,4例患者的上睑下垂症状均恢复,恢复时间为7~30 d。3例患者眼球运动完全恢复,恢复时间为7~30 d;1例部分恢复。3例患者的复视完全恢复,恢复时间为30 d至6个月;1例缓解。有瞳孔扩大的3例患者,1例术后7 d恢复,2例未恢复。结论初步研究显示,采用神经内镜经鼻入路下进行眶尖、眶上裂、视神经管、视柱依次减压的手术方案可对动眼神经裂段进行有效且安全的减压,有助于患者部分神经功能的恢复。Objective To preliminarily explore the efficacy of neuroendoscopic transnasal decompression in the treatment of traumatic oculomotor nerve palsy.Methods A retrospective analysis was conducted on the clinical data of 4 patients with traumatic oculomotor nerve palsy who were treated with neuroendoscopic transnasal decompression at the Department of Neurosurgery,Suzhou Kowloon Hospital,Shanghai Jiao Tong University school of medicine from January 2016 to January 2022.The surgical strategy of decompressing the orbital apex,superior orbital fissure,optic canal,and optic strut was performed in sequence.Three-dimensional CT was reviewed after surgery to clarify the degree and scope of decompression,and the improvement of oculomotor nerve palsy symptoms was followed up.Results All 4 patients were successfully operated,and intraoperative and postoperative imaging confirmed that the medial edge of the superior orbital fissure was adequately decompressed.None of the patients had surgery-related complications.During the 1-year follow-up period after surgery,the ptosis symptoms of all 4 patients recovered,and the recovery time was 7 to 30 days.Three patients had complete recovery of eye movements,with recovery time ranging from 7 to 30 days;1 patient had partial recovery.Three patients had complete recovery of diplopia,with recovery time ranging from 30 days to 6 months;1 patient had remission.Of the 3 patients with pupil mydriasis,1 recovered 7 days after surgery and 2 did not recover.Conclusion Preliminary research shows that the surgical plan of sequentially decompressing the orbital apex,superior orbital fissure,optic canal,and optic strut under transnasal neuroendoscopy can effectively and safely decompress the oculomotor nerve fissure segment,which can contribute to the recovery of some neurological functions of patients.

关 键 词：自然腔道内镜手术 脑损伤 动眼神经疾病 减压术 外科 治疗结果 

分 类 号：R651.1[医药卫生—外科学]