Pterional orbita decompression in orbital hemorrhage and trauma.
BACKGROUND
This article presents a series of patients with traumatic retrobulbar hematoma and orbital trauma, treated with extended pterional orbital decompression.


METHODS
Fifteen patients, showing symptomatic retrobulbar hematoma or symptoms of orbital injury after various trauma mechanisms, were treated with deep lateral orbital decompression and removal of orbital blood/bone fragments via this approach. Preoperative and postoperative course, neuroradiologic findings, additional brain or facial injuries, and outcome of eye function are analyzed in detail.


RESULTS
Mean delay between trauma and decompression was 70 hours (3 days), with a range from 2 hours to 15 days. Proptosis decreased in all patients and visual acuity improved or remained normal in nine patients and stayed defective in four. Impaired extraocular movements and pupillary changes recovered in 10 patients. Apart from one case of permanent deficit of the frontal branch of the facial nerve, no severe complications were seen.


CONCLUSIONS
The presented pterional orbital decompression represents an effective alternative approach for patients with sight-threatening retrobulbar hematoma or orbital trauma, especially in cases that require direct access to damaged structures and maximal decompression of the orbit. Immediate detection and treatment of orbital hematomas is mandatory for acceptable outcome of eye function.
Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany. marcus.korinth@post.rwth-aachen.de
Marcus C
MC
Korinth
Azize
A
Ince
Werner
W
Banghard
Beate C
BC
Huffmann
Joachim M
JM
Gilsbach
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D005094:Exophthalmos / Q000209:etiology; D005133:Eye Movements; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000293:injuries*; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019315:Retrobulbar Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014792:Visual Acuity