Importance of Preoperative Pupillary Reflex in Traumatic Optic Neuropathy.

IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Journal of Korean Neurosurgical Society Pub Date : 2024-08-13 DOI:10.3340/jkns.2024.0083
Min Ho Lee, Tae-Kyu Lee
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Abstract

Objective: Traumatic optic neuropathy (TON) refers to a pathological condition caused by direct or indirect injury to the optic nerves. In the case of patients with traumatic brain injury, adequate vision evaluation is difficult in many cases due to altered mentality. In order to address this problem, we investigated preoperative pupillary light reflex in TON patients as a predictive factor of surgical outcomes after optic nerve decompression.

Methods: From April 2020 to September 2022, we enrolled patients who were diagnosed with TON and underwent endoscopic optic nerve decompression at our institution. Vision and pupil reflex tests were performed by an ophthalmologist before and after surgery.

Results: Seven patients were enrolled. Their ages ranged from 9 to 78 years and all were male. Among the 7 patients, the patient whose pupillary light reflex was 6mm with sluggish and 7mm with fixated pupil before surgery showed no improvement in vision. Patients with some response to direct reflex or contralateral indirect reflex testing preoperative showed vision improvement postoperative.

Conclusion: Direct and indirect pupillary reflexes can be important factors determining treatment for TON. In unconscious patients with a fracture involving the optic canal, timely surgical intervention based on pupillary reflex can prevent permanent loss of vision.

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创伤性视神经病变术前瞳孔反射的重要性
目的:创伤性视神经病变(TON)是指视神经受到直接或间接损伤而引起的一种病理状态。对于脑外伤患者而言,由于精神状态的改变,很多情况下很难对视力进行充分评估。为了解决这一问题,我们研究了TON患者术前瞳孔对光反射作为视神经减压术后手术效果预测因素的情况:方法:2020 年 4 月至 2022 年 9 月,我们招募了在我院确诊为 TON 并接受内窥镜视神经减压术的患者。手术前后由眼科医生进行视力和瞳孔反射测试:结果:共招募了七名患者。他们的年龄从 9 岁到 78 岁不等,均为男性。在这 7 名患者中,手术前瞳孔对光反射为 6 毫米(迟钝)和 7 毫米(固定)的患者视力没有改善。术前对直接反射或对侧间接反射测试有一定反应的患者术后视力有所改善:结论:直接和间接瞳孔反射是决定治疗瞳孔强直的重要因素。对于视神经管骨折的昏迷患者,根据瞳孔反射进行及时的手术干预可以防止永久性视力丧失。
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来源期刊
CiteScore
2.90
自引率
6.20%
发文量
109
审稿时长
3-8 weeks
期刊介绍: The Journal of Korean Neurosurgical Society (J Korean Neurosurg Soc) is the official journal of the Korean Neurosurgical Society, and published bimonthly (1st day of January, March, May, July, September, and November). It launched in October 31, 1972 with Volume 1 and Number 1. J Korean Neurosurg Soc aims to allow neurosurgeons from around the world to enrich their knowledge of patient management, education, and clinical or experimental research, and hence their professionalism. This journal publishes Laboratory Investigations, Clinical Articles, Review Articles, Case Reports, Technical Notes, and Letters to the Editor. Our field of interest involves clinical neurosurgery (cerebrovascular disease, neuro-oncology, skull base neurosurgery, spine, pediatric neurosurgery, functional neurosurgery, epilepsy, neuro-trauma, and peripheral nerve disease) and laboratory work in neuroscience.
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