Orbital Expansion in Cranial Vault After Minimally Invasive Extradural Transorbital Decompression for Thyroid Orbitopathy

Ramesh, Sathyadeepak; Nobori, Alexander; Wang, Yi; Rootman, Daniel B.; Goldberg, Robert A.

doi:10.1097/iop.0000000000001124

Cited by 12 publications

(3 citation statements)

References 23 publications

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“…Such a large reduction in proptosis is not always necessary (our mean proptosis was 24.51 ± 1.76 mm preoperatively). In cases needing significant reduction of proptosis, a medial decompression can be associated, widely exposing the dura [54]. We did not encounter any CSF leak.…”

Section: Discussionmentioning

confidence: 90%

Deep Lateral Wall Partial Rim-Sparing Orbital Decompression with Ultrasonic Bone Removal for Treatment of Thyroid-Related Orbitopathy

Bengoa-González

Galindo‐Ferreiro

Mencía‐Gutiérrez

et al. 2019

Journal of Ophthalmology

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Purpose To describe the results of thyroid-related orbitopathy (TRO) treated by ultrasonic deep lateral wall bony decompression with partial rim sparing (DLW-PRS). Methods A review was carried out, from January 2015 to September 2017, of all patients treated with ultrasonic DLW-PRS decompression using a SONOPET® (Stryker, Kalamazoo, MI, USA) ultrasonic aspirator, using a lateral, small triangle flap incision for access. The primary outcome was the change in proptosis (measured by the difference in Hertel exophthalmometry measurements). Other secondary outcomes were changes in visual acuity (VA) (using Snellen scale, decimal fraction), presence of lagophthalmos, eyelid retraction (measured by upper eyelid margin distance to the corneal reflex (MRD1) and lower eyelid margin distance to the corneal reflex (MRD2), and presence of exposure keratopathy). Results A total of 58 orbital decompressions in 35 patients were reviewed, with 23 patients (65.7%) having bilateral decompressions. There was a female preponderance with 26 patients (74.2%), and the mean age ± standard deviation was 52.6 ± 13.9 years. Mean proptosis was 24.51 ± 1.76 mm preoperatively, reduced to 19.61 ± 1.27 mm in final follow-up. The mean reduction was 4.9 ± 1.54 mm. VA improved from 0.8 ± 0.14 to 0.9 ± 0.12, p=0.039. 5 of 13 patients (38.4%) with preoperative diplopia reported improvement or complete resolution after surgery. MRD1 was reduced from 5.25 ± 0.88 mm to 4.49 ± 0.7 mm. MRD2 was also reduced from 6.3 ± 0.88 mm to 5.0 ± 0.17 mm. Presence of lagophthalmos was reduced from 35 eyes (60.3%) to five (8.6%); the presence of epiphora was also reduced from 20 patients (57.1%) to 3 (8.5%) following decompression. Complications of the surgery included zygomatic hypoaesthesia in 14 (40%) patients in the early postoperative period and chewing alterations in 10 (28.5%) of the patients. All of these complications were resolved at the 6-month follow-up visit. We noted no surgical complications such as ocular or soft tissue damage, infection, inflammation, or visual loss. Conclusions The SONOPET® ultrasonic bone curette can be used safely and effectively for DLW orbital decompression surgery. The main benefits were good visualization and handling of tissues and speed and ease of use of the equipment. This trial is registered with ClinicalTrials.gov identifier: NCT04025034.

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Section: Discussionmentioning

confidence: 90%

Deep Lateral Wall Partial Rim-Sparing Orbital Decompression with Ultrasonic Bone Removal for Treatment of Thyroid-Related Orbitopathy

Bengoa-González

Galindo‐Ferreiro

Mencía‐Gutiérrez

et al. 2019

Journal of Ophthalmology

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“…Another notable feature of this report was the possibility for greater exposure of the dura. Although the report merely explained that the dura mater becomes a posterior anatomical landmark, another report published by Goldberg et al presented evidence of more effective decompression [26]. Goldberg et al [20] showed that exposing the dura, which is in contact with the posterior…”

Section: Journal Of Endocrinology and Thyroid Researchmentioning

confidence: 99%

The Historical Evolution of Orbital Decompression

Someda,

Kakizaki

2023

JETR

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The earliest account of orbital decompression was published in 1888. Since then, various approaches have been reported throughout the years -transcutaneous, transnasal, transcranial, transantral, transconjunctival, transcaruncular, temporal fossa, swinging eyelid, ab interno, and ab externo. The current trend for orbital decompression includes four surgical techniques: 1) Deep lateral orbital decompression with or without medial orbital wall decompression (balanced decompression); 2) Orbital fat decompression; 3) Deep lateral orbital decompression via transtemporal fossa approach; and 4) Endoscopic medial orbital wall decompression with or without orbital floor decompression. The choice of surgical procedure may differ in every case, depending on the severity of proptosis and the surgeon's preference or skill. With the advancements in technology, orbital decompression is continuously transforming. Nonetheless, the main goal has always been to achieve a more effective decompression for disfiguring proptosis and compressive optic neuropathy.

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“…3). 27 The deep lateral wall is approached through a lateral eyelid crease incision, with wide periosteal dissection from the mid-superior orbital rim to the mid-inferior orbital rim and back to the superior and inferior orbital fissures (Fig. 3).…”

Section: Systematic Approachmentioning

confidence: 99%

Orbital Decompression: Conceptual Approach for Orbital Volume Expansion

Goldberg,

Gout

2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To review the advances in the surgical techniques of orbital decompression. Methods: A literature review of orbital decompression surgery and experience-based consideration of bony areas for decompression. Results: In the 100-year-plus span of orbital decompression literature, multiple incisions and multiple bone and fat removal strategies have been described. In general, bone removal has been conceptualized as consisting of 4 walls of the orbit. However, the orbital bony anatomy is more subtle than a simple box, and considering 6 areas of potential bony removal allows a more nuanced paradigm for clinical decision-making and for understanding various technique descriptions. Historical and current techniques, and surgical planning and decision-making, are described from the perspective of a 6 area paradigm. Potential complications are reviewed. Conclusion: A conceptual framework for orbital decompression focusing on 6 potential areas of bone removal provides a nuanced and flexible paradigm for understanding and describing surgical techniques, and for designing individualized surgery. Orbital decompression surgery should be customized to the patient’s anatomy and symptoms.

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Orbital Expansion in Cranial Vault After Minimally Invasive Extradural Transorbital Decompression for Thyroid Orbitopathy

Abstract: With wide exposure of the middle cranial fossa dura following extradural transorbital decompression, orbital tissue typically expands in the cranial vault.

Cited by 12 publications

References 23 publications

Deep Lateral Wall Partial Rim-Sparing Orbital Decompression with Ultrasonic Bone Removal for Treatment of Thyroid-Related Orbitopathy

Deep Lateral Wall Partial Rim-Sparing Orbital Decompression with Ultrasonic Bone Removal for Treatment of Thyroid-Related Orbitopathy

The Historical Evolution of Orbital Decompression

Orbital Decompression: Conceptual Approach for Orbital Volume Expansion

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