Analysis of curative effect of traumatic optic nerve injury and selection of surgical strategy for optic canal fracture

doi:10.3877/cma.j.issn.2095-9141.2022.01.005

Abstract

Abstract:

Objective

To investigate the efficacy of optic canal decompression in the treatment of traumatic optic nerve injury (TON), evaluate the related factors affecting the prognosis, and analyze the surgical strategy of different parts of optic canal fracture.

Methods

The clinical data of 58 patients who underwent optic nerve decompression after TON in the Neurosurgery Department of The Second Affiliated Hospital of Air Force Military Medical University from January 2011 to June 2020 were analyzed retrospectively. Univariate and multivariate Logistic regression analysis were used to evaluate the potential prognostic factors. According to the different positions of optic canal fractures, craniotomy optic nerve decompression and transnasal endoscopic decompression were selected to evaluate the effects of different surgical methods on the improvement of postoperative visual acuity in patients with different fracture positions.

Results

All 58 patients with TON underwent optic nerve decompression, and the postoperative visual acuity of 33 patients was improved (improvement group), including 9 cases of craniotomy optic nerve canal decompression and 24 cases of transnasal endoscopic decompression; The postoperative visual acuity of 25 patients was not improved (not improved group), including 8 cases of craniotomy optic canal decompression and 17 cases of transnasal endoscopic decompression. Univariate and multivariate Logistic regression analysis determined that preoperative visual acuity and optic canal fracture were independent influencing factors for postoperative visual acuity improvement. The effective rate of patients with light perception was significantly higher than that of patients without light perception, and the postoperative improvement rate of patients without optic canal fracture was significantly higher than that of patients with optic canal fracture. Among the 35 patients with single optic canal fracture, transnasal endoscopic optic nerve decompression had a better prognosis for the inner lower wall fracture of optic canal, and craniotomy decompression was more beneficial for the outer upper wall fracture.

Conclusion

Optic canal decompression had a good effect in the treatment of TON, especially for patients with light perception before operation. For the patients with optic canal fracture, a reasonable surgical method should be selected according to the fracture location for optic nerve decompression.

Key words: Traumatic, Optic canal fracture, Optic nerve Injury, Craniotomy, Endoscopic

Hang Wang, Yaning Cai, Lijun Heng, Shunnan Ge, Yan Qu. Analysis of curative effect of traumatic optic nerve injury and selection of surgical strategy for optic canal fracture[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(01): 23-27.

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References 15

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因素		改善组（n=33）	未改善组（n=25）	χ²/t值	P值
年龄（岁，±s）		32.39±14.03	34.08±14.16	0.451	0.653
受伤类型[例（%）]				0.343	0.952
	车祸	14（42.4）	12（48.0）
	打击	1（3.0）	1（4.0）
	砸伤	1（3.0）	1（4.0）
	坠落	17（51.5）	11（44.0）
伤后意识[例（%）]				0.045	0.832
	昏迷	11（33.3）	9（36.0）
	清醒	22（66.7）	16（64.0）
蝶筛出血[例（%）]				2.419	0.120
	有	13（39.4）	15（60.0）
	无	20（60.6）	10（40.0）
术前视力[例（%）]				10.261	0.016
	无光感	16（48.5）	22（88.0）
	光感	8（24.2）	1（4.0）
	手动	7（21.2）	2（8.0）
	数指	2（6.1）	0
受伤至手术时间[例（%）]				1.414	0.702
	≤3 d	11（33.3）	10（40.0）
	4~7 d	9（27.3）	8（32.0）
	8~14 d	5（15.2）	4（16.0）
	>14 d	8（24.2）	3（12）
手术方式[例（%）]				0.153	0.695
	开颅	9（27.3）	8（32.0）
	经鼻内镜	24（72.7）	17（68.0）
视神经管骨折[例（%）]				6.249	0.012
	是	21（63.6）	23（92.0）
	否	12（36.4）	2（8.0）

因素		改善组（n=33）	未改善组（n=25）	χ²/t值	P值
年龄（岁，±s）		32.39±14.03	34.08±14.16	0.451	0.653
受伤类型[例（%）]				0.343	0.952
	车祸	14（42.4）	12（48.0）
	打击	1（3.0）	1（4.0）
	砸伤	1（3.0）	1（4.0）
	坠落	17（51.5）	11（44.0）
伤后意识[例（%）]				0.045	0.832
	昏迷	11（33.3）	9（36.0）
	清醒	22（66.7）	16（64.0）
蝶筛出血[例（%）]				2.419	0.120
	有	13（39.4）	15（60.0）
	无	20（60.6）	10（40.0）
术前视力[例（%）]				10.261	0.016
	无光感	16（48.5）	22（88.0）
	光感	8（24.2）	1（4.0）
	手动	7（21.2）	2（8.0）
	数指	2（6.1）	0
受伤至手术时间[例（%）]				1.414	0.702
	≤3 d	11（33.3）	10（40.0）
	4~7 d	9（27.3）	8（32.0）
	8~14 d	5（15.2）	4（16.0）
	>14 d	8（24.2）	3（12）
手术方式[例（%）]				0.153	0.695
	开颅	9（27.3）	8（32.0）
	经鼻内镜	24（72.7）	17（68.0）
视神经管骨折[例（%）]				6.249	0.012
	是	21（63.6）	23（92.0）
	否	12（36.4）	2（8.0）

危险因素	回归系数	标准误	Wald值	P值	OR值	95%CI
视神经管骨折	1.776	0.864	4.224	0.040	5.903	1.086~32.097
术前视力	-1.978	0.731	7.329	0.007	0.138	0.033~0.579

危险因素	回归系数	标准误	Wald值	P值	OR值	95%CI
视神经管骨折	1.776	0.864	4.224	0.040	5.903	1.086~32.097
术前视力	-1.978	0.731	7.329	0.007	0.138	0.033~0.579

骨折位置		例数	上壁+外壁（n=12）	内壁+下壁（n=23）
开颅		9
	改善		4（33.33）	2（8.70）
	未改善		1（8.33）	2（8.70）
经鼻内镜		26
	改善		3（25.00）	12（52.17）
	未改善		4（33.33）	7（30.43）
χ²值			0.686	0.240
P值			0.408	0.642

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