前床突气化感染致球后视神经炎视神经减压1例报告

摘要

[Summary] In this article, a 60 year-old female with nasal obstruction, purulent nasal discharge and ophthalmodynia was presented.The patient was diagnosed as having inflammation of the pneumatized anterior clinoid process and retrobulbar neuritis.A three-dimensional reconstruction of surgery related area was done before the operation.The patient received endoscopic anterior clinoidectomy and optic nerve decompression under surgical navigation system.The visual acuity was improved from no light perception to light perception on the operation day, and improved to handmovement after 3 months.At 3 months postoperation, fundus examination found no specific finding, and nasal endoscopy showed epithelization of the anterior clinoid process cavity.At 6 months postoperation, the visual acuity was stable and no symptoms of nasal obstruction and ophthalmodynia.Though with a relatively rare occurrence, retrobulbar neuritis caused by the inflammation of pneumatized anterior clinoid process damages the optic never severely.Effective treatment should be performed as soon as possible.As a minimally invasive surgery, endoscopic anterior clinoidectomy is an effective and safe treatment, with the support of three-dimensional reconstruction and theassistance of surgical navigation system.%本文报道1例60岁女性因脓涕、鼻塞及视力下降入院，诊断为前床突气化感染、球后视神经炎。术前对相关术区行三维重建，术中导航下经鼻内镜径路行前床突气房开放、病变清除术及视神经减压术。术后当日患者左眼由无光感提高到可见光感，术后3个月左眼可见眼前手动，鼻内镜下见前床突气房及视神经管表面上皮化良好，眼底检查未见明显异常。术后6个月左眼视力稳定于可见眼前手动，无鼻堵、眼痛等不适。我们认为前床突气化感染致球后视神经炎疾病罕见，对视神经危害严重，应尽早施行有效的治疗手段，经鼻内镜径路的前床突气房开放、病变清除术微创、安全、有效，同时采用导航及三维重建对手术起到良好的辅助作用。