[Neurosurgical treatment of patients with severe thyroid-associated ophthalmopathy. Transcranial two-wall orbital decompression].

INTRODUCTION: Thyroid-associated ophthalmopathy is most often seen in patients with Graves' disease. Surgical decompression is rarely used in Denmark. We report the results of neurosurgical two-wall orbital decompression in a consecutive group of patients. MATERIAL AND METHODS: From 1997 to 2000 we used a uniform technique and a standardised follow-up of 52 orbital decompressions in 27 patients. All the patients were assessed preoperatively, and at one month and one year postoperatively. Visual acuity, proptosis (Hertel ophthalmometry), soft tissue involvement, and eye motility were recorded and graded according to a modified NOSPECS scale. RESULTS: As reduced visual acuity was present in only a few patients, it was not significantly changed during follow-up. No case with worsening was seen. Proptosis had decreased by a mean of 3.4 mm (0-9 mm) in the first month and by 3.9 mm (0-9 mm) at one year. Twenty-three patients had reduced eye motility before and 15 one month after operation. Eye motility improved in all 15 patients. Soft tissue involvement was present in 21 patients (40 eyes) before and in 10 patients (19 eyes) one month after operation and improved in all ten patients. Soft tissue involvement was further reduced one year after operation. A total of ten patients received glucocorticoid treatment before and during the operation. The corresponding figures were six at one month and four at one year. One patient had a lesion of one frontal branch of the facial nerve. No other side effects were encountered. DISCUSSION: Transcranial two-wall orbital decompression is effective in patients with thyroid-associated ophthalmopathy and complications seem rare. This surgical method is superior to other surgical approaches as regards the effect on eye motility.