Abstract：
To investigate the effectiveness of optic nerve decompression (OND) in the treatment of severe traumatic optic neuropathy (TON) through pterional and supraorbital approaches, and to identify the prognostic factor for postoperative visual acuity (VA) following OND. Patients with severe TON treated with OND through either pterional or supraorbital approach in our institute from September 2019 to June 2022 were retrospectively reviewed in this study. Demographic information, trauma factors, the interval between trauma and complete blindness, the interval between trauma and surgery, and the associated craniofacial traumas were recorded. Hospitalization days and the postoperative VA of patients in two groups were compared. There were 54 severe TON patients with NLP included in this study; 21 patients underwent OND through the pterional approach, and the other 33 underwent the supraorbital approach. Respectively, in groups of pterional and supraorbital approaches, the average hospitalization days were 9.8 ± 3.2 and 10.7 ± 2.9 days (p = 0.58), the mean durations of follow-up were 18.9 ± 4.3 and 20.8 ± 3.7 months (p = 0.09), and the average circumference of OND were 53.14 ± 15.89 ◦ (range 220 ◦ -278◦) and 181.70 ± 6.56◦ (range 173 ◦ -193◦) (p<0.001). The overall improvement rates of pterional and supraorbital approaches are 57.1% and 45.5% (p = 0.40), respectively. Optic canal fracture (OCF) was revealed to be significantly associated with postoperative VA in the supraorbital approach (Binary: p = 0.014, CI: 1.573-57.087; Ordinal: p = 0.003, CI: 1.517-5.503), but not in the pterional approach. In the group of supraorbital approach, patients with OFC had a higher rate of a better outcome (78.6%) than those without (21.4%). Patients with severe traumatic TON may benefit from OND through either the pterional or supraorbital approach. OCF is a potential prognostic factor for postoperative VA following OND through the supraorbital approach.
摘要：
目的探讨经翼点和眶上入路视神经减压术(OND)治疗严重外伤性视神经病变(TON)的疗效,并确定OND术后视力（VA）的预后因素。本研究回顾性分析了2019年9月至2022年6月在我们研究所通过翼点或眶上入路治疗的重度TON患者。人口统计信息,创伤因素，创伤和完全失明之间的间隔，创伤和手术之间的间隔，并记录了相关的颅面创伤。比较两组患者的住院天数和术后VA。本研究包括54例严重的TONNLP患者；21例患者通过翼点入路进行了OND，另外33人接受了眶上入路。分别,在翼点和眶上方法组中，平均住院天数为9.8±3.2和10.7±2.9天(p=0.58),平均随访时间为18.9±4.3和20.8±3.7个月(p=0.09),OND的平均周长分别为53.14±15.89○（范围220○-278○）和181.70±6.56○（范围173○-193○）（p<0.001）。翼点和眶上入路的总体改善率分别为57.1%和45.5%(p=0.40),分别。视管骨折（OCF）显示与眶上入路术后VA显着相关（二进制：p=0.014，CI：1.573-57.087；序数：p=0.003，CI：1.517-5.503），但不是在翼方法中。在眶上入路组中，OFC患者的预后较好(78.6%)高于无OFC患者(21.4%).患有严重创伤性TON的患者可以通过翼点或眶上入路从OND中受益。OCF是通过眶上入路OND术后VA的潜在预后因素。
