Zusammenfassung
Hintergrund
Die Indikation zur chirurgischen Optikusdekompression nach Trauma gilt als umstritten. Das chirurgische Trauma soll eine zusätzliche Nervenläsion erzeugen mit der Gefahr eines kompletten Visusverlusts. Alternativ wird eine konservative Hochdosis-Kortisontherapie empfohlen.
Methoden
In einem etablierten Tiermodell mit 29 Wistar-Ratten werden die funktionellen und morphologischen Läsionsfolgen einer kalibrierten ein- und zweizeitigen Optikuskompression untersucht.
Ergebnisse
In Abhängigkeit von der gewählten Läsionszeit und -stärke wurde eine lineare Abnahme der Neuronenzahl in der RGC- (Retinal-ganglion-cell-)Schicht sowie eine zunehmende Reaktivität für GFAP („glial fibrillary acidic protein“) als Zeichen einer zentralen Gliose der Astrozyten beobachtet, jedoch unabhängig davon, ob eine ein- oder zweizeitige Läsion vorlag.
Schlussfolgerungen
Die Indikation zur operativen Entlastung eines afferenzgeschädigten Auges sollte – insbesondere bei der geringen Morbidität des rhinochirurgischen Zugangswegs – großzügiger gestellt werden, um sekundäre Sehnervenschäden und Folgeschäden im zentralen visuellen System zu reduzieren, die mit dem Andauern der Läsion zunehmen können.
Abstract
Background
Surgical optic decompression after trauma has been discussed controversially. The surgical trauma is supposed to produce an additional nerve lesion with the danger of complete loss of vision. Alternatively, conservative high dose cortisone therapy has been recommended.
Methods
The functional and morphological consequences of a lesion after calibrated optic compression in one or two sessions were examined in an animal model using 29 Wistar rats.
Results
Depending on the duration and intensity of the lesion, we observed a linear decline in the number of neurons in the RGC (retinal ganglion cell) layer as well as an increasing reactivity to GFAP (glial fibrillary acidic protein) as an indication of central gliosis of astrocytes; however, this was independent on whether optic compression was performed in one or two sessions.
Conclusions
To reduce secondary damage to the visual nerve and the central visual system that might increase with a persisting lesion, the indication for surgical relief of an eye affected by afference should be considered liberally, especially in view of the low morbidity of rhinosurgical intervention.
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Gellrich, NC., Kankam, J., Maier, W. et al. Ein- und zweizeitige Sehnervenläsionen im Tiermodell und dessen klinischer Stellenwert. HNO 54, 761–767 (2006). https://doi.org/10.1007/s00106-006-1387-6
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DOI: https://doi.org/10.1007/s00106-006-1387-6
Schlüsselwörter
- Indirekte Lichtreaktion
- Visueller Kortex
- Mikroläsionsapparatur
- Chirurgische Optikusdekompression
- Optikuskompression