Transcranial orbital decompression for progressive compressive optic neuropathy after 3-wall decompression in severe graves' orbitopathy.
OBJECTIVE
To determine surgical outcomes after transcranial decompression of the superior orbit in patients with progressive compressive optic neuropathy (CON) secondary to Graves' orbitopathy (GO) who had previously been treated with 3-wall decompression.


METHODS
Approval from the West Virginia University Institution Review Board was obtained. A retrospective review of 4 patients with GO who received bilateral transcranial decompression of the orbits for progressive compressive optic neuropathy after bilateral maximal extracranial 3-wall decompression was performed. The patients were treated by the Multidisciplinary Orbit and Skull Base Services at West Virginia University and the University of Michigan.


RESULTS
Bilateral transcranial decompression of the orbit for GO was performed on 8 orbits in 4 patients. All 8 orbits had radiographic evidence of compression of the orbital apex, and all patients had been treated with steroids, orbital radiation, and bilateral 3-wall decompression. Preoperative vision ranged from 20/25 to 20/100, which improved to 20/25 or better in all eyes. The visual field mean deviation improved from a mean of -13.05 to -1.67 dB. Hertel measurements improved from a mean of 19.25 to 15.25 mm. Extraocular motility was essentially unchanged. Two patients were noted to have asymptomatic ocular pulsations. There were no other complications, and all patients remained stable during a follow-up period of 5 years (range 2-8 years).


CONCLUSIONS
Transcranial decompression is an effective and safe method of salvaging vision when standard treatments fail. This is only the second report of transcranial decompression for refractory compressive optic neuropathy after decompression from a standard approach.
*Department of Ophthalmology, West Virginia University Eye Institute; †Department of Neurosurgery, West Virginia University, Morgantown, West Virginia; ‡Department of Otolaryngology, and §Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A.
Chad M
CM
Bingham
Matheson A
MA
Harris
Ira A
IA
Vidor
Charles L
CL
Rosen
John V
JV
Linberg
Lawrence J
LJ
Marentette
Victor M
VM
Elner
Jennifer A
JA
Sivak-Callcott
D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000601:surgery*; D009901:Optic Nerve Diseases / Q000209:etiology / Q000601:surgery*; D009915:Orbit / Q000601:surgery*; D009916:Orbital Diseases / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology