Transcranial orbital decompression for progressive compressive optic neuropathy after 3-wall decompression in severe...

Area of Science:

• Ophthalmology
• Neurosurgery
• Endocrinology

Background:

• Graves' orbitopathy (GO) can cause compressive optic neuropathy (CON) due to orbital apex compression.
• Standard treatments like steroids, radiation, and 3-wall decompression may not resolve CON.
• Transcranial decompression offers an alternative surgical approach for refractory cases.

Observation:

• A retrospective review of 4 patients with GO and CON previously treated with 3-wall decompression was conducted.
• All patients underwent bilateral transcranial decompression of the superior orbit.
• Radiographic evidence confirmed orbital apex compression in all cases.

Findings:

• Vision improved to 20/25 or better in all 8 treated orbits.
• Visual field mean deviation improved significantly from -13.05 dB to -1.67 dB.
• Proptosis (Hertel measurements) decreased from a mean of 19.25 mm to 15.25 mm, with no change in motility.

Implications:

• Transcranial decompression is a safe and effective salvage procedure for vision in refractory CON secondary to GO.
• This technique provides a valuable option when conventional decompression methods are insufficient.
• Further research can explore long-term outcomes and refine surgical techniques.