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Traumatische Optikusneuropathie

Langzeitergebnisse nach endonasaler mikrochirurgischer Dekompression des N. opticus

Traumatic optic nerve neuropathy

Longterm results following microsurgical optic nerve decompression

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Zusammenfassung

Hintergrund

Die traumatische Optikusneuropathie (TON) ist als Verletzung des N. opticus bei Schädel- oder Schädel-Hirn-Trauma mit konsekutivem Visusverlust definiert. Die Therapie dieser Erkrankung wird kontrovers diskutiert. In der Studie wurden Visuswerte vor und nach endonasaler mikrochirurgischer N.-opticus-Dekompression und im Langzeitverlauf sowie Zusammenhänge zwischen Visuserholung und Zeit zwischen Trauma und Operation (Op.) untersucht.

Patienten und Methoden

Bei 20 vigilanten Patienten mit einseitiger TON wurden ophthalmologische Befunde erhoben sowie eine Magnetresonanztomographie (MRT) und eine Computertomographie (CT) der Orbita und des N.-opticus-Kanals durchgeführt. In allen Fällen erfolgte eine mikrochirurgische N.-opticus-Dekompression, mehrtägige hochdosierte Kortisontherapie sowie die Ermittlung des Visus präoperativ und innerhalb der ersten 2 Tage postoperativ. Zusätzlich lagen von 15 Patienten Visuswerte nach etwa 3 Monaten postoperativ vor.

Ergebnisse

Bei 45% der Patienten bestand postoperativ ein Visusanstieg von >0,4, bei 3 weiteren Patienten (15%) von 0,1–0,2. Günstig für die postoperative Visuserholung waren weniger als 24 h zwischen Trauma und Op. sowie der Nachweis eines Optikusscheidenödems oder -hämatoms. Ungünstig waren ein Zeitintervall >24 h, ein Frakturverlauf durch den Nervenkanal und eine initiale komplette Amaurose. Im Langzeitverlauf stieg bei weiteren 4 Patienten der Visus um >0,2. Es kam weder zur Visusverschlechterung noch zu schwerwiegenden operativen Komplikationen.

Schlussfolgerung

Nach mikrochirurgischer N.-opticus-Dekompression und hochdosierter Kortisontherapie ist eine Visussteigerung bei über 50% der Patienten mit TON zu beobachten. Die Op. sollte indiziert werden bei Nachweis eines Optikusscheidenhämatoms bzw. -ödems oder Frakturfragmenten im Nervenkanal und möglichst umgehend nach dem Trauma erfolgen.

Abstract

Background

Traumatic optic nerve neuropathy (TON) is defined as injury to the optic nerve with subsequent vision loss due to head or craniocerebral trauma. The treatment of this disease is the subject of controversial discussions. The purpose of the present study was to investigate pre- and immediate postoperative visual acuity in patients with unilateral TON and to compare the results with the time interval between trauma and surgical intervention.

Patients and Methods

A total of 20 patients with unilateral TON and considerable vision loss were examined. All were treated with high dose corticoids and underwent microsurgical optic nerve decompression. Visual acuity was determined pre- and postoperatively. In long-term follow-up visual acuity was determined 3 months postoperatively.

Results

Postoperatively, nine patients (45%) achieved an improvement in visual acuity of more than 0.4, and another three patients (15%) an improvement of ≥0.2. At 3 months postoperatively another four patients achieved a further improvement of their visual acuity of >0.2. A decrease in visual acuity was not observed in any case, nor were major surgical complications.

Conclusions

Factors which predict good prognosis for vision recovery include a short time interval between trauma and intervention, edema, and/or hematoma of the optic nerve sheath. Factors which predict a worse prognosis are a fracture line directly through the nerve canal, a time period between trauma and intervention of more than 24 h, and initial complete amaurosis.

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Authors and Affiliations

  1. Hals-Nasen-Ohren-Klinik, Regionale plastische Chirurgie, Klinikum Nordstadt, Klinikum Region Hannover GmbH, Haltenhoffstraße 41, 30167, Hannover, Deutschland

    H.-J. Welkoborsky, H. Möbius & L. Bauer

  2. Augenklinik, Klinikum Nordstadt, Klinikum Region Hannover GmbH, Hannover, Deutschland

    B. Wiechens

  3. Interdisziplinäres Orbitazentrum Hannover, Hannover, Deutschland

    H.-J. Welkoborsky, H. Möbius, L. Bauer & B. Wiechens

Authors
  1. H.-J. Welkoborsky
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  2. H. Möbius
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  3. L. Bauer
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  4. B. Wiechens
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Correspondence to H.-J. Welkoborsky.

Additional information

Auszugsweise vorgetragen auf der 10. Jahresversammlung der Norddeutschen Gesellschaft für Otorhinolaryngologie und zervikofaziale Chirurgie, 04.06.–06.06.2010, Lübeck.

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Welkoborsky, HJ., Möbius, H., Bauer, L. et al. Traumatische Optikusneuropathie. HNO 59, 997–1004 (2011). https://doi.org/10.1007/s00106-011-2266-3

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