O-P-1
OPERATIVE DECOMPRESSION OF THE ORBIT IN PATIENTS WITH GRAVES’
DISEASE
A.
Cekov 1 , Chr. Tzekov 1 , S. Cherninkova 2 , S. Kondoff 1 , H.Kostadinova
1 ,Y.Enchev
3
1) Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
2) Department of Neurology (Neuroophthalmology), Aleksandrovska hospital,
Sofia, Bulgaria
3) Department of Neurosurgery, St. Marina hospital, Varna, Bulgaria
BACKGROUND: Optical neuropathy is a result of intraorbital compression caused by inflammatory edema with auto-immune genesis of extraocular muscles and other intraorbital structures in patients with impaired thyroid functions. The reason for the exophtalmus is the high intraorbital pressure and respectively- volume pressure in the orbit grows up to 9,7 +/-
4,8 mmHg (normal range 4,4 +/- 2,2 mmHg N). Loss of visual functions, as well as corneal ulcerations and proptosis are the most serious complications of this disease. The severe forms of this pathology are amendable of surgical treatment with aims of orbital decompression.
OBJECTIVE: To describe and analyze our experience in the surgical treatment of thyroid ophthalmopathy and to compare our results with the ones in the literature.
METHODS: In the Department of neurosurgery, Tokuda Hospital Sofia, Bulgaria, 2 patients with thyroid ophthalmopathy were operated on. The first patient is a 48 years old female with a history of thyrotoxicosis for about 10 years and additional comorbidity with meningeoma of the sphenoid wing. She underwent a decompression on both sides using extended pterional approach and the minimally invasive supraorbital approach. The second patient is 56 years old female with thyroid pathology for 7-8 years. She was operated using the superolateral orbitomy.
RESULTS: The two patients were discharged from the hospital with improved visual status and good cosmetic result. On 1 year follow up there was a significant reduction of the exophthalmos
CONCLUSION: Thyroid ophthalmopathy is a serious complication of thyroid dysfunction with potential severe complications. Operative treatment is indicated in selected cases, where orbital management strategies are decompression of optic nerve and bulb reposition with minimal iatrogenic impairment.