J Korean Ophthalmol Soc.  2014 Mar;55(3):337-342. 10.3341/jkos.2014.55.3.337.

Evaluation of Stereotactic Navigation During Orbital Decompression in Thyroid-Associated Orbitopathy Patients

• Lim KS
• Lee JK

• KMID: 2218259
• DOI: http://doi.org/10.3341/jkos.2014.55.3.337

Abstract

PURPOSE
To evaluate the use of stereotactic navigation during orbital decompression surgery.
METHODS
We conducted a retrospective analysis of 27 patients (48 orbits) with thyroid-associated orbitopathy who underwent orbital decompression. Stereotactic navigation was performed on 28 orbits of 15 patients, and orbital decompression surgery without navigation was performed on 20 orbits of 12 patients. The changes in medial wall, lateral wall and inferior wall orbital volume in CT scans and horizontal and vertical eyeball deviation after surgery were analyzed in the 2 patient groups.
RESULTS
The mean decompressed volume of orbits was significantly increased in the lateral wall decompression with stereotactic navigation patient group than without stereotactic navigation (p < 0.05, p = 0.025). However, in the inferior wall and the medial wall decompression, there was no significant difference between the 2 groups. The changes of horizontal and vertical deviation were not significant between the 2 groups and no patient experienced neural damage.
CONCLUSIONS
The stereotactic navigation during lateral orbital wall decompression is a safe and effective method for inducing greater decompressed volume.

Keyword

Computed tomography; Lateral wall decompression; Navigation; Orbital decompression

MeSH Terms

Decompression*
Humans
Orbit*
Retrospective Studies
Tomography, X-Ray Computed

Figure

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  Figure 1. (A) Operating setup. A patient reference is placed under the patient’s zygoma (white arrow head). The AxiEM ™ Localizing emmiter generating an electromagnetic field is positioned right beside the patient’s head (white arrow) by the fixation accessary (black arrow). We register patient information by AxiEM ™ system pointer probes (black arrow head). (B) Intraoperative screen shot of a surgical field. We could know operating location on CT (axial, coronal, sagittal plane) by AxiEM ™ system pointer probes.

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  Figure 2. The expanded area at each orbital slice was marked from the imaginary preoperative wall border to the decompressed bony edge, and the marked areas were calculated with Image J software. The deep lateral wall was analyzed on axial CT planes, as well as medial and inferior walls on coronal planes. The summation of all surface areas (cm2) multiplied by 0.25 cm (2.5 mm) was considered as an expanded orbital volume (cm3) in each orbital wall. (A) Axial CT plane. (B) Coronal plane.

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  Figure 3. The decompression surgery induce esotropia (3.48 ± 1.214 prism diopter) (A) and reduce vertical strabismus (-0.67 ± 0.671 prism diopter) (B). However, between using the navigation or not, there was no significant difference in horizontal or vertical strabismal change (Mann-Whitney test).

Reference

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