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1 病例摘要患者男,26岁,因车祸左颞部撞伤,左眼视力进行性减退,2天后失明.检查无光感,瞳孔散大,直接对光反射消失,间接对光反射存在.眼底视盘色淡余无殊.伤后5天在全麻下经鼻外筛-蝶窦行左视神经减压术.术中见后筛房部分骨折、蝶窦前壁骨折,窦内有凝血块.去除窦腔粘膜,在蝶窦侧壁中段见较明显的颈内动脉压迹隆起,以此为标志,在其外上方找到半管状隆起之视神经骨管,并见其上有裂缝.沿此逐步凿开视神经骨管全程约半周.检查视神经鞘膜完整,无明显水肿、血肿等.未切开鞘膜及腱环.术时尽量保持术腔勿与鼻腔直接沟通.
1 case summary Male, 26 years old, due to a car accident left temporal impact, visual impairment of the left eye, blindness after 2 days. No light perception examination, mydriasis, light reflex disappeared directly, there is indirect light reflex. Discoid discoloration special .5 days after injury by transnasal external suturing under general anesthesia - sphenoid sinus left decompression surgery. See intraoperative part of the screen after the fracture of the sphenoid anterior wall fracture, there is a clot within the sinus. Removal of sinus mucosa, in the middle of the sphenoid sinus wall to see the more obvious traces of internal carotid artery uplift, as a sign above the outside to find the semi-tubular uplift of the optic nerve of the bone canal and see there are cracks on it. Chisel the optic nerve by about half a week of bone throughout the examination of the optic nerve sheath intact, no significant edema, hematoma, etc .. Not open the sheath and tendon ring surgery to try to keep the operating room do not communicate directly with the nasal cavity.