endoscopic transnasal optic canal decompression

In addition to eyeball penetrating injuries, head trauma, especially mid-face fractures and lateral trauma of the eyebrows can also cause severe visual impairment or blindness. Unlike direct eye damage, this type of blindness after trauma is caused by direct damage to the optic nerve in the inner segment or secondary optic nerve compression due to edema, hemorrhage, and fracture. Decompression of the optic nerve canal is a surgical procedure for treating optic nerve contusion. Transnasal and sinus optic nerve decompression is the most convenient and minimally invasive. Endoscopic surgery of the nasal cavity and sinus surgery makes the endoscopic transnasal optic canal decompression gradually replace the craniotomy, the maxillary sinus sinus and the optic canal decompression through the sacral approach to become the mainstay of optic canal decompression Surgery. Treatment of diseases: ocular trauma Indication 1. Delayed vision loss, surgical decompression, that is, some vision after injury, and then gradually decreased or lost vision. 2. It is generally believed that the visual acuity of the injured person is lost, and the chance of successful surgical treatment is paralyzed. However, if the visual acuity is restored after a large amount of corticosteroids and mannitol reduce edema, or if there is light, surgical decompression should be considered. 3. Those with residual vision or partial vision after injury. 4. Immediately after vision, the visual acuity is lost. If the treatment is not improved, surgery can also be considered. The literature reported that although non-surgical treatment of visual acuity did not recover, some of the visual acuity recovered after surgical decompression. 5. Can not rely on the presence or absence of a neural tube fracture to determine whether the surgical decompression or not. Foreign literature reports that optic canal decompression should be performed within a few hours after the injury. The complete visual loss is more than 24h. The operation is often poor, so the operation is classified as emergency surgery. However, it has been reported in the literature that the effective rate of surgery within 10 days after injury is 72%, and the effective rate of surgery exceeds 15% over 10 days. So the sooner the surgery is, the better. Contraindications 1. Sinusitis. 2. Patients with severe head injury or bleeding. 3. Patients with disturbance of consciousness. Preoperative preparation 1. Ophthalmology check physical vision, vision and fundus. 2. Full physical examination, pay attention to abnormal nervous system. 3. A sinus axial and coronal CT scan provides information on the eyelids, sinus and surrounding structures. 4. Conventional preoperative preparation for general anesthesia. Surgical procedure 1. Contract the nasal mucosa 1% tetracaine or saline 20ml+1:1000 adrenaline 2ml contract nasal mucosa 2 to 3 times. 2. Excision of the uncinate process, opening the sputum, using a sickle knife or an anti-bite forceps to remove the uncinate process, and then using a nipper to bite the sieving. 3. Excision of the sinus sinus air chamber pushes the middle turbinate to the septum side, enlarges the visual field, and removes the air chamber in the ethmoid sinus according to the Messerklinger method. In the operation, it is often seen that there are old blood in the ethmoid sinus and fracture marks of the sieve room. 4. Excision of the anterior wall of the sphenoid sinus as much as possible to remove the anterior wall of the sphenoid sinus to enlarge the field of vision. There is often stale blood in the sinus and should be aspirated. 5. Identify the optic canal and surrounding structures to identify visual nodules and optic canal processes, observe the fracture of the apex, sphenoid sinus, and the impact on the optic canal. 6. Open the optic canal with the electric drill along the optic canal axially thin the optic canal bone to the use of curettes, peeling off the easier to pick small pieces of bone. Then, according to the facial nerve decompression method, the small bone piece is removed with a curette and a peeling piece, and the neural tube bone is opened. If the optic canal has been fractured, the bone piece can be easily removed and the optic canal can be directly opened. 7. If the optic nerve is swollen, the optic nerve sheath can be cut with a small file. There may be a small amount of cerebrospinal fluid rhinorrhea. 8. Hemostasis and occlusion of the optic canal should be adequately stopped after the opening of the optic canal. It can be compressed by cotton pad. The larger bleeding point can be electrocoagulated to stop bleeding. 9. After the operation cavity is filled with no active bleeding, the operation cavity is flushed with antibiotic saline, and then the operation cavity is filled with an expansion sponge.