受傷から1週間が経過した外傷性視神経症に対し視神経管開放術を施行した1例

A case of traumatic optic neuropathy treated by decompression of optic canal one week after injury

要約　目的：受傷7日目の外傷性視神経症に対し視神経管開放術が有効であった1例の報告。

症例：39歳の男性が自転車走行中に乗用車と接触して転倒。頭蓋骨骨折による気脳症のため総合病院脳神経外科入院。受傷7日目に当科受診。初診時の左矯正視力0.01，左眼の相対的求心性瞳孔障害陽性，左眼瞼外方に受傷痕を認めた。左眼視野は鼻側周辺のみであった。頭部CTで左視神経管上壁陥凹を認め，同日内視鏡下経鼻的視神経管開放術を施行し，術翌日よりステロイドパルス療法を併用した。左眼の中心暗点は術翌日より消失した。治療開始後37日目に左視力1.0となった。

結論：受傷1週間が経過した外傷性視神経症に対して外科療法およびステロイド全身投与を行い良好な経過を得た。

Abstract　Purpose：To report a case who developed traumatic optic neuropathy and who was treated by decompression of optic canal one week later.

Case：A 39-year-old collided with a passenger car and fell doen while riding a bicycle. He was treated at a general hospital because of skull fracture with pneumocephalus. He was referred to us one week later. His corrected visual acuity was 1.2 in the right eye and 0.01 in the left. The visual field in the left eyes was limited to the nasal sector. Computed tomography showed fracture superior to the left optic canal. The patient received endoscopic optic nerve decompression, followed by corticosteroid pulse therapy from the next day after surgery. Visual acuity improved to 1.0 37 days after surgery.

Conclusion：This case of traumatic optic neuropathy improved after surgical decompression and corticosteroid pulse therapy starting one week after injuly.