1
|
Khan RI, Golahmadi AK, Killeen RP, O' Brien DF, Murphy C. Image-guided navigation in posterior orbital tumour surgery: a comparative cohort study. Orbit 2024:1-10. [PMID: 38687963 DOI: 10.1080/01676830.2024.2343299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE The posterior orbit is a confined space, harbouring neurovascular structures, frequently distorted by tumours. Image-guided navigation (IGN) has the potential to allow accurate localisation of these lesions and structures, reducing collateral damage whilst achieving surgical objectives. METHODS We assessed the feasibility, effectiveness and safety of using an electromagnetic IGN for posterior orbital tumour surgery via a comparative cohort study. Outcomes from cases performed with IGN were compared with a retrospective cohort of similar cases performed without IGN, presenting a descriptive and statistical comparative analysis. RESULTS Both groups were similar in mean age, gender and tumour characteristics. IGN set-up and registration were consistently achieved without significant workflow disruption. In the IGN group, fewer lateral orbitotomies (6.7% IGN, 46% non-IGN), and more transcutaneous lid and transconjunctival incisions (93% IGN, 53% non-IGN) were performed (p = .009). The surgical objective was achieved in 100% of IGN cases, with no need for revision surgery (vs 23% revision surgery in non-IGN, p = .005). There was no statistically significant difference in surgical complications. CONCLUSION The use of IGN was feasible and integrated into the orbital surgery workflow to achieve surgical objectives more consistently and allowed the use of minimal access approaches. Future multicentre comparative studies are needed to explore the potential of this technology further.
Collapse
Affiliation(s)
- Rizwana I Khan
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- School of Medicine, Royal College of Surgeons Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Ronan P Killeen
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Donncha F O' Brien
- School of Medicine, Royal College of Surgeons Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Department of Neurosurgery, National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
| | - Conor Murphy
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- School of Medicine, Royal College of Surgeons Ireland University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
2
|
Olivetto M, Testelin S. Surgical navigation in maxillofacial surgery: A French national survey. J Stomatol Oral Maxillofac Surg 2023; 124:101468. [PMID: 37080359 DOI: 10.1016/j.jormas.2023.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE to gain a national understanding of the utilization of surgical navigation among maxillofacial surgeons in France through a web-based questionnaire. METHODS A 14-point multiple-choice questionnaire was created and distributed to the participants, divided into two sections. The first section gathered general information about the respondents, and the second section provided an overview of the use of surgical navigation. RESULT A total of 75 participants completed the survey. The results showed that a majority of university hospital departments (65%) utilize an intra-operative 3D imaging system, while very few private clinics and general hospitals use this technology. CONCLUSION The survey suggests that surgical navigation is primarily used in university centers in French maxillofacial surgery, with limited utilization and non-standardized indications for use.
Collapse
Affiliation(s)
- Matthieu Olivetto
- Department of Maxillofacial Surgery, Hospital Center of Annecy-Genevois, Annecy, France.
| | - Sylvie Testelin
- Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, Amiens, France
| |
Collapse
|
3
|
Araya J, Sabharwal S, Briceño CA. Surgery in Thyroid Eye Disease. Int Ophthalmol Clin 2023; 63:91-107. [PMID: 36963830 DOI: 10.1097/iio.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
|
4
|
Abstract
Graves' orbitopathy (GO) is a complex autoimmune disorder of the orbit that causes the eye to appear disfigured. GO is typically associated with Graves' disease, an inflammatory autoimmune condition that is caused by thyrotropin receptor autoantibodies. Although our knowledge of the pathophysiology of GO has improved, its exact pathogenesis remains unclear. Some patients suffer from disfigurement, double vision, and even vision loss rather than hyperthyroidism. The disease severity and activity prompt different treatments, as the signs of GO are heterogeneous, so their management can be very complex. Despite medical advances, the first-line treatment for moderate-to-severe active GO is still glucocorticoids, while surgery can be critical for the treatment of chronic inactive GO. Surgery is sometimes required in the acute phase of the disease when there is an immediate risk to vision, such as in dysthyroid optic neuropathy. Most surgeries for GO are rehabilitative and subdivided into three categories: decompression, strabismus repair, and lid surgery. This review is a basic overview of the field, with up-to-date knowledge of the surgical techniques for GO. We review and summarize recent literature on the advances in surgery for GO to provide up-to-date insights on the optimal surgical treatment for GO.
Collapse
Affiliation(s)
- Joonyoung Baeg
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Han Sol Choi
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Charm Kim
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
- Department of Ophthalmology, AIN Woman`s Hospital, Incheon, Republic of Korea
| | - Hyuna Kim
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Jang
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| |
Collapse
|
5
|
Zhang S, Wu Y, Wang Y, Sun R, Sun J, Fan X, Li Y, Zhou H. Endoscope-navigation-assisted orbital decompression for graves' orbitopathy. Eur J Ophthalmol 2023:11206721231152628. [PMID: 36718496 DOI: 10.1177/11206721231152628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To compare the surgical outcomes of endoscope-navigation (EN)-assisted orbital decompression and non-EN-assisted orbital decompression for Graves' orbitopathy (GO) and to assess the potential clinical advantage of EN in orbital decompression surgery. METHODS This retrospective cohort study was performed on 227 orbits of 147 GO patients who underwent EN-assisted orbital decompression (185 orbits) or non-EN-assisted orbital decompression (42 orbits). Assessment included proptosis reduction, best-corrected visual acuity (BCVA), diplopia, ocular restriction and surgical complications. RESULTS The proptosis reduction in the EN group was 0.9 mm greater than that in the non-EN group in the entire cohort (p = 0.004) and 1.0 mm greater than that in the non-EN group in the propensity score matching cohort (p = 0.025) at 2 years postoperatively. In all, 78.2% of orbits with sight-threatening GO in the EN group and 52.6% of orbits in the non-EN group showed BCVA improvement (p = 0.026). The proportion of patients with improvement in diplopia was significantly greater in the EN group than in the non-EN group (p = 0.026). CONCLUSIONS EN offers anatomical localization and deep-seated tissue visualization in orbital decompression and significantly improves the surgical outcomes for GO.
Collapse
Affiliation(s)
- Shuo Zhang
- 569160Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yu Wu
- 569160Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yang Wang
- 569160Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Rou Sun
- 569160Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jing Sun
- 569160Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- 569160Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yinwei Li
- 569160Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Huifang Zhou
- 569160Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| |
Collapse
|
6
|
Lee B, Chen Y, Topilow N. Stereotactic navigation in orbital decompression surgery – Does it shorten operative time and improve outcomes? Taiwan J Ophthalmol 2022; 12:35-38. [PMID: 35399975 PMCID: PMC8988976 DOI: 10.4103/tjo.tjo_60_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/29/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE: Stereotactic navigation is being increasingly used for orbital decompression (OD). Recent studies have cited clinical benefits of navigation including greater proptosis reduction but have differed regarding effects on operative time. This study aimed to evaluate navigated vs. non-navigated OD with respect to operative time and proptosis reduction. MATERIALS AND METHODS: Retrospective nonrandomized comparative trial of navigated vs. nonnavigated OD. Operative time and proptosis reduction were recorded and analyzed for all patients. RESULTS: A total of 30 orbital decompressions were included; 14 were performed with stereotactic navigation (SN), and 16 were performed without SN. On average, the SN group took 19 minutes longer for 3-wall decompressions (p = 0.185), 25 minutes shorter for balanced decompressions (p = 0.025), and 18 minutes longer (p = 0.067) for lateral wall decompressions. Mean proptosis reduction (PR) in 3-wall decompressions was greater in the SN group (p = 0.02). Among balanced wall decompressions, mean PR was 4.25 mm and 3.67 mm for the SN and non-SN groups (p = 0.30), respectively. For lateral wall decompressions, mean PR was 2.63 mm with SN and 2.50 mm without SN (p = 0.45). CONCLUSIONS: This study showed no difference in operative times between navigated and non-navigated OD, although empirical experience showed variable times required for registration and intraoperative troubleshooting of the navigation system. This study also found that navigation increased proptosis reduction for all types of OD. Further randomized controlled trials are needed to better understand the impact of navigation technology on operative times and surgical outcomes.
Collapse
|
7
|
Ong AA, DeVictor S, Vincent AG, Namin AW, Wang W, Ducic Y. Bony Orbital Surgery for Graves' Ophthalmopathy. Facial Plast Surg 2021; 37:692-697. [PMID: 34500489 DOI: 10.1055/s-0041-1735638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The majority of Graves' ophthalmopathy, or thyroid eye disease, can be managed medically; however, in refractory or severe cases, surgical intervention with orbital decompression may be necessary. The majority of the published literature is retrospective in nature, and there is no standardized approach to orbital decompression. The purpose of this review is to evaluate the various surgical approaches and techniques for orbital decompression. Outcomes are ultimately dependent on individual patient factors, surgical approach, and surgeon experience.
Collapse
Affiliation(s)
- Adrian A Ong
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Samuel DeVictor
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York
| | - Aurora G Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Arya W Namin
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Weitao Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester, Rochester, New York
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| |
Collapse
|
8
|
Reshef ER, Yoon MK. Advanced Techniques in Orbital Decompression Surgery: Recent Advances. Int Ophthalmol Clin 2021; 61:89-105. [PMID: 33743531 DOI: 10.1097/IIO.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|