硬膜外前床突起切除と視神経管開放により著明な視力改善が得られた外傷性視神経損傷の1手術例

Usefulness of Extradural Optic Canal Unroofing and Decompression of the Optic Nerve for Improvement of Visual Acuity in Traumatic Optic Neuropathy

Ⅰ．はじめに

　外傷性視神経損傷に対する治療には経過観察，ステロイドを使用した保存的治療，視神経管を開放する外科的手術療法が存在するが，標準的治療方針は未だ確立されてはいない．治療法の選択，その適切な時期については前向き無作為臨床研究はなされておらず，統一した見解は得られていないためおのおのの症例で個別に判断されているのが現状である．今回われわれは硬膜外前床突起切除と視神経管開放により，著明な視力の改善が得られた外傷性視神経損傷の1手術例を経験したので文献的考察を加えて報告する．

　An 81-year-old man presented with poor visual acuity of the left eye, swelling of the left eyelid, and elevation of the left intraocular pressure after contusion of the left palpebral portion. CT revealed left ocular proptosis and left intraorbital hematoma. Traumatic optic neuropathy was suspected, and emergent optic nerve decompression was performed through extradural anterior clinoidectomy followed by optic canal release. Postoperatively, his left visual acuity was markedly improved and the elevated intraocular pressure decreased. Postoperative CT demonstrated improvement of the left ocular proptosis and decompression of the optic nerve. Emergent optic canal release has been recommended in patients who have suffered visual dysfunction caused by optic canal fracture or intraorbital hematoma. The advantages of extradural anterior clinoidectomy followed by optic canal release include a shorter surgical route and easy identification of the optic nerve, resulting in fewer surgical complications. In addition, this procedure can achieve intraorbital decompression. We recommend extradural anterior clinoidectomy followed by optic canal release as a safe and reliable procedure for optic nerve decompression in patients with traumatic optic neuropathy.