THE SPHENOIDAL SINUS IN OPTIC-NERVE DECOMPRESSION

Surgical decompression of the orbit may be necessary in dysthyroid pat ients with compressive optic neuropathy, Two-wall decompression with a trans-antral or a trans-conjunctival approach is commonly used, Howev er, in some patients the initial improvement following this surgical p rocedure is not maintained, Although this may be due to disease progre ssion, a variant of orbital anatomy can contribute to sub-optimal deco mpression, We report three cases in which recurrence of compressive op tic neuropathy occurred following two-wall decompression, The sphenoid al sinus was placed anteriorly in these patients, Further decompressio n which included the lateral wall of the sphenoidal sinus resulted in improvement. An endoscopic approach provides superior access and visib ility for decompression of the optic nerve into the sphenoidal sinus, and this approach may be the surgical treatment of choice in these cas es.