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Pterional Orbita Decompression in Orbital Hemorrhage and Trauma

Korinth, Marcus C. MD; Ince, Azize MD; Banghard, Werner MD; Huffmann, Beate C. MD; Gilsbach, Joachim M. MD

Journal of Trauma and Acute Care Surgery: July 2002 - Volume 53 - Issue 1 - p 73-78
Original Articles

Background  This article presents a series of patients with traumatic retrobulbar hematoma and orbital trauma, treated with extended pterional orbital decompression.

Methods  Fifteen patients, showing symptomatic retrobulbar hematoma or symptoms of orbital injury after various trauma mechanisms, were treated with deep lateral orbital decompression and removal of orbital blood/bone fragments via this approach. Preoperative and postoperative course, neuroradiologic findings, additional brain or facial injuries, and outcome of eye function are analyzed in detail.

Results  Mean delay between trauma and decompression was 70 hours (3 days), with a range from 2 hours to 15 days. Proptosis decreased in all patients and visual acuity improved or remained normal in nine patients and stayed defective in four. Impaired extraocular movements and pupillary changes recovered in 10 patients. Apart from one case of permanent deficit of the frontal branch of the facial nerve, no severe complications were seen.

Conclusion  The presented pterional orbital decompression represents an effective alternative approach for patients with sight-threatening retrobulbar hematoma or orbital trauma, especially in cases that require direct access to damaged structures and maximal decompression of the orbit. Immediate detection and treatment of orbital hematomas is mandatory for acceptable outcome of eye function.

From the Departments of Neurosurgery (M.C.K., A.I., B.C.H., J.M.G) and Ophthalmology (W.B.), University Hospital RWTH Aachen, Aachen, Germany.

Submitted for publication May 2, 2001.

Accepted for publication March 6, 2002.

Address for reprints: Marcus C. Korinth, MD, Department of Neurosurgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52057 Aachen, Germany; email:

© 2002 Lippincott Williams & Wilkins, Inc.