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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Pterional orbit decompression in Grave’s disease with dysthyroid optic neuropathy

Pterionale Orbitadekompression bei endokriner Orbitopathie mit Optikusneuropathie

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  • presenting/speaker Jürgen Grauvogel - Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
  • Sebastian Küchlin - Medical Center, University of Freiburg, Ophthalmology, Freiburg, Deutschland
  • Christian Scheller - Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
  • Wolf Lagreze - Medical Center, University of Freiburg, Ophthalmology, Freiburg, Deutschland
  • Jürgen Beck - Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
  • Christine Steiert - Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP008

doi: 10.3205/21dgnc296, urn:nbn:de:0183-21dgnc2968

Published: June 4, 2021

© 2021 Grauvogel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: The choice of surgical technique in sight-threatening Grave’s orbitopathy remains controversial. Available data are mostly derived from mixed cohorts with multiple surgical indications and techniques. The authors assessed predictors for visual outcome after standardized pterional orbital decompression for dysthyroid optic neuropathy (DON).

Methods: Retrospective analysis of 62 pterional orbital decompressions performed on 40 patients with DON.

Results: Visual acuity improved by an average of 3.8 lines in eyes with preoperative visual impairment (95% confidence interval [CI]: 1.8 – 5.8 lines, p < 0.001) and remained stable in eyes without prior visual impairment (95% CI -1.3 – 1 lines, p = 0.81). Proptosis was reduced by an average of 3.1 mm (95% CI 1.8 – 4.3 mm, p < 0.001). Higher degrees of proptosis were predictive of worse visual outcomes (p = 0.017). New-onset diplopia developed in two patients, while previous diplopia resolved after surgery in six patients.

Conclusion: This cohort is the largest series of pterional orbit decompressions, and the first to focus exclusively on dysthyroid neuropathy. Complication rates were low. Decompression surgery was highly effective at restoring and maintaining visual acuity in patients with dysthyroid optic neuropathy.