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E.J. Wladis, S. Baredes, P.D. Langer; Use of Intraoperative Navigation in Orbital Decompression Surgery for Thyroid Orbitopathy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):161.
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Purpose: Computerized navigation systems that allow for precise localization of intraoperative anatomic position have recently emerged as useful adjuvants for head, neck, and neurologic surgery. However, the application of such systems in orbital surgery has been limited. We describe our experience using computerized intraoperative navigation to assist in performing endoscopic decompression of the medial orbital wall as part of three-wall decompression for thyroid orbitopathy. Methods: Retrospective chart review of patients with thyroid orbitopathy and exophthalmometry readings of at least 25 mm who underwent extensive three-wall decompression surgery emloying intraoperative navigation. Results: Twenty eyes of fourteen patients underwent three-wall orbital decompression surgery for thyroid orbitopathy using intraoperative navigation during endoscopic medial wall decompression. No breaks in the fovea ethmoidalis or cribiform plate were observed, and no cases of post-operative CSF rhinorrhea were noted. Post-operative CT scans revealed extensive removal of the ethmoid sinus, often extending immediately adjacent to the skull base. At a mean follow-up time of 5.2 months, the average decrease in proptosis was 6.4 mm (SD=2.38), as measured by Hertel exophthalmometry. Conclusions: Given its ability to specifically localize surgical position, intraoperative navigation enhances the ability to perform endoscopic medial wall orbital decompression by allowing a more complete removal of the ethmoid sinus. Localizing the exact area of ethmoidectomy intraoperatively allows a greater margin of safety when removing superior ethmoid air cells near the skull base. Clinicians should be aware of this emerging modality and should consider employing it in orbital decompression surgery for patients with thyroid orbitopathy.
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