Artikel
Decompression of endocrine orbitopathy via an extradural pterional approach
Extradurale pterionale Dekompressionsbehandlung bei schweren Formen der endokrinen Orbitopathie
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Autoren
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Uta Schick
- Neurochirurgische Klinik, Wedau Klinikum Duisburg, Zu den Rehwiesen 9, 47055 Duisburg
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W. Hassler
- Neurochirurgische Klinik, Wedau Klinikum Duisburg, Zu den Rehwiesen 9, 47055 Duisburg
| Veröffentlicht: | 23. April 2004 |
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Gliederung
Text
Objective
When medication and/or radiation therapy fail in endocrine orbitopathy, indications for decompression are optic neuropathy, severe orbital inflammation, reduction of excessive proptosis, and severe keratopathy. Numerous surgical decompression techniques have been described. We present an overview of the treatment and clinical outcome of 13 patients with endocrine ophthalmopathy and 20 orbital decompressions, carried out in our center from 1995 to 2002.
Methods
Decompression of the antero- and posterolateral wall, of the roof, of the optic canal, and the superior orbital fissure was performed in all cases via an extradural pterional approach.
Results
The mean duration of symptoms was 13 months (range 3-42 mo) in the whole group, and 8.15 months in optic neuropathy. Concerning the degree of EO 3 patients (4 orbits) had exophthalmos only (stage 3, Werner classification), 2 patients (3 orbits) had diplopia only (stage 4), 1 patient (2 orbits) cornea ulceration (stage 5), and 7 patients (11 orbits) optic nerve neuropathy (stage 6). Surgery reduced the degree of exophthalmos in all patients, and improved eye motility and diplopia. Proptosis reduction at 3 months after surgery averaged 4.75 mm. A mean of 0.29 of better visual acuity could be achieved. There was no loss of visual acuity. Intraocular tension could be reduced by 9.05 mm Hg on average. No diplopia was induced.
Conclusions
The pterional approach facilitates adequate proptosis reduction without induction of diplopia and allows adequate decompression of the orbital apex, the superior orbital fissure, and the optic canal. This technique represents an effective and low-risk alternative to other techniques.
