Decompression of endocrine orbitopathy via an extended extradural pterional approach.

Abstract

Numerous surgical decompression techniques have been described in endocrine orbitopathy. We present an overview of the treatment and clinical outcome of 13 patients with endocrine ophthalmopathy and 20 orbital decompressions via an extradural pterional approach, carried out in our center from 1995 to 2002. Decompression of the antero- and posterolateral wall, of the roof, and the superior orbital fissure was performed in all cases. Surgery reduced the degree of exophthalmos in all patients, and improved eye mobility and diplopia. Proptosis reduction at 3 months after surgery averaged 4.75 mm. A mean of 0.29 of better visual acuity was also achieved. There was no loss of visual acuity. Intra-ocular tension was reduced by 9.05 mm Hg on average. No diplopia was induced. The pterional approach facilitates adequate proptosis reduction without inducing any double vision and allows adequate decompression of the orbital apex, and of the superior orbital fissure. This technique represents an effective and low-risk alternative to other techniques.