A 22-year-old man with a history of neurosurgery for astrocytoma of the cerebellum and trunk on the right side at the age of 2 years, was observed for postoperative paresis of the right facial nerve with lagophthalmos in his childhood. The presence of asymptomatic dysfunction of the right trigeminal nerve was also noted. At the age of 22 years, after right eyeball contusion, the vision of the right eye decreased and a persistent epithelial defect developed, followed by corneal ulceration. Due to the exhaustion of therapeutic options in a young patient with corneal anaesthesia, the cornea was reinnervated via the contralateral supraorbital nerve using an autologous sural nerve graft. Five months after the surgery, the sensitivity of the cornea of the right eye began to recover. After amniotic membrane transplantation, the extensive epithelial defect healed, and the opaque corneal stroma gradually cleared up.
The reinnervation of the anaesthetic cornea (corneal neurotization) using the supraorbital nerve and the autologous sensory nerve graft represents a new solution for severe NK treatment. The severe corneal condition in our patient healed after the surgery.
一名22岁男子,有右侧小脑和躯干星形细胞瘤的神经外科病史,2岁,在他的童年时期观察到右面神经术后轻瘫伴眼球。还注意到右三叉神经无症状功能障碍的存在。在22岁的时候,右眼挫伤后,右眼视力下降,出现持续性上皮缺损,其次是角膜溃疡。由于年轻的角膜麻醉患者的治疗选择用尽,使用自体腓肠神经移植,通过对侧眶上神经对角膜进行神经再灌注。手术五个月后,右眼角膜的敏感性开始恢复。羊膜移植后,广泛的上皮缺损愈合,不透明的角膜基质逐渐清除。
使用眶上神经和自体感觉神经移植物对麻醉角膜的神经支配(角膜神经化)代表了严重NK治疗的新解决方案。我们患者的严重角膜状况在手术后愈合。