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

Kyung Sup Lim; Jeong Kyu Lee

doi:10.3341/jkos.2014.55.3.337

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Lim and Lee: Evaluation of Stereotactic Navigation During Orbital Decompression in Thyroid-Associated Orbitopathy Patients

Original Article

J Korean Ophthalmol Soc 2014;55(3):337-342.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.3.337

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

Kyung Sup Lim, MD, Jeong Kyu Lee, MD, PhD

Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea

Address reprint requests to Jeong Kyu Lee, MD, PhD Department of Ophthalmology, Chung-Ang University Hospital, #102 Heukseok-ro, Dongjak-gu, Seoul 156-755, Korea, Tel: 82-2-6299-1665, Fax: 82-2-825-1666, E-mail: lk1246@hanmail.net

Received 25 May 201326 August 2013 Accepted 28 January 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 induc-ing greater decompressed volume.

Keywords: Computed tomography, Lateral wall decompression, Navigation, Orbital decompression

References

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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.

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.

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).

Table 1.

Demographics of study population

Demographic	Using Navigation	Not Using Navigation	Total	p-value
Total No. of orbits (patients)	28 (15)	20 (12)	48(27)
Sex (Male / Female)	7 / 21	3 / 17	10 / 38	0.488^†
Age (years)	37.2 ± 14.4	41.7 ± 15.2	39.3 ± 14.7	0.286^*
Duration of dysthyroidism (years)	5.9 ± 2.2	5.3 ± 1.8	5.6 ± 2.0	0.545^*
Preoperative exophthalmometry	19.4 ± 2.5	20.1 ± 2.2	19.9 ± 2.4	0.332^*
Steroid therapy (%)	7 (25.0)	4 (20.0)	11 (22.9)	0.741^†
Radiotherapy (%)	4 (14.3)	2 (10.0)	6 (12.5)	1.000^†
Thyroidectomy (%)	9 (32.10	4 (20.0)	13 (27.1)	0.512^†
Smoking (%)	6 (21.4)	3 (15.0)	9 (18.8)	0.716^†
Bony decompression of orbital wall
1-wall : DLW (%)	0 (0.0)	2 (10.0)	2 (4.2)
2-wall : Balancing DLW and med. wall (%	%) 11 (39)	5 (25.0)	16 (33.3)
2-wall : Med. and inf. wall (%)	0 (0.0)	3 (15.0)	3 (6.3)
3-wall : DLW, med. and inf. wall (%)	17 (60.7)	10 (50.0)	27 (56.3)

Values are presented as mean ± SD.

DLW = deep lateral wall; SD = standard deviation.

^* p-value in Mann-Whitney test

^† p-value in Fisher's exact test.

Table 2.

Decompression volume at different areas

Area of Decompression	Volume (cm³)
Area of Decompression	Navigation	No Navigation	p-value	Total
Deep lateral orbital wall	0.503 ± 0.140^† (28 cases)	0.412 ± 0.118^† (17 cases)	0.025^*	0.470 ± 0.138^† (45 cases)
Medial orbital wall	0.824 ± 0.355^† (28 cases)	0.712 ± 0.335^† (18 cases)	0.287^*	0.780 ± 0.348^† (46 cases)
Inferior orbital wall	0.239 ± 0.262^† (17 cases)	0.224 ± 0.196^† (13 cases)	0.853^*	0.230 ± 0.232^† (30 cases)

Values are presented as mean ± SD.

^* Significant p-value in Mann-Whitney test

^† Estimated value by computed tomography analysis.

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