Surgical decompression

If steroid therapy fails or is contraindicated, irradiation of the posterior orbit, using well-collimated high-energy x-ray therapy, will frequently result in marked improvement of the acute process. Threatened loss of vision is an indication for surgical decompression of the orbit. Eyelid or eye muscle surgery may be necessary to correct residual problems after the acute process has subsided. 

Peri-infarct edema reduces local cerebral blood flow and causes brain shift and herniation, the last being the most common neurological cause of death. This complication is a common explanation for worsening over the first few days and can often be detected by CT scan. Intravenous mannitol may reduce the deficit for a while but is unlikely to have a major impact on outcome. Recently, surgical decompression using hemicraniectomy has been shown to improve survival, with satisfactory functional outcome in many patients (Ch. 21). 

Surgical decompression for malignant middle cerebral artery infarction... 

The natural history of Graves disease is of alternating remission and relapse. Progression to hypothyroidism can occur, especially after 1 treatment. Such patients should have long-term follow-up, and are likely to require thyroid hormone replacement therapy Severe forms of thyroid eye disease should be treated with steroids and immunosuppresants or low-dose radiotherapy. Urgent surgical decompression can be required for eyophthalmos. 

For both CRVO and BRVO the pathophysiology includes the formation of thrombosis within the venule, typically at the crossing point of an arteriole and venule in the case of BRVO, and at or just posterior to the lamina cribrosa in the case of CRVO. In both instances the compartment syndrome model has been proposed whereby the vein is partially compressed by the adjacent arteriole artery within a restricted space. This can lead to turbulence of blood flow, and secondary development of thrombosis. Surgical decompression of the vein or the surrounding structures has been proposed as a therapeutic procedure for both disorders. 

Osterloh MD, Charles S. Surgical decompression of branch retinal vein occlusions. Arch Ophthalmol 1998 106 1469-1471. 

In case of a splash, the washing must be immediate and intensive with a strong detergent soap and water. Treatment must be supportive. 2,3-Dimercaptopropanol-l (BAL), penicillamine, and ethylenediamine-MIV.lV. N -tetraacetate (EDTA) are ineffective. Cerebral edema can be relieved by surgical decompression [42]. 

After surgical decompression, the US appearance and mobility of the afferted nerves may improve, and it is possible to visualize the altered morphology of the osteofibrous tunnel after release of the retinaculum (Martinoli et al. 2000b E1-Karabaty et al. 2005). 

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