The surgical treatment of malignant exophthalmos.
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A procedure has been developed for maximizing decompression in patients with nonspecific orbital inflammatory disease or dysthyroid orbitopathy that involves removal of parts of all four orbital walls through a lateral orbitotomy using a 30-mm incision combined with a canthotomy and an inferior cul-de-sac incision. The procedure has been performed on seven orbits of four patients who had greater than 30 mm of forward placement of the eyes as measured by Hertel exophthalmometry and/or a 10-mm difference in the forward placement of the two eyes, indications considered for this procedure. The procedure has resulted in 10-17 mm of reduction in proptosis in these patients, which is consistently greater than that obtained by any other procedure. A complication of spinal fluid leak resulted in the recommendation that the procedure not be performed in patients over 65 whose dura is considered too thin to prevent spontaneous leakage and minimal surgical trauma. In all circumstances, this procedure must be performed by an experienced neuro-ophthalmic orbital surgical team.
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Intracranial transtemporal orbital decompressions in one case of massive fibrous dysplasia of temporal, parietal and maxillary bones and in two cases of meningioma of the sphenoidal region are described. Surgery for fibrous dysplasia, even if extensive, must always be modified according to cosmetic and functional aspects. In bone-invading meningioma, large decompressing resections should be made. They may save the eye and arrest the progress of the disease for long periods of time.
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