Orbital metastases secondary to neuroendocrine tumors are exceedingly rare. We present a unique case of a 30-year-old female initially presenting with fever, chills, periorbital swelling, and painful proptosis. CT orbits revealed two ovoid-shaped ring-enhancing lesions in the right lateral and superior rectus muscles and clear sinuses, atypical for infectious post-septal cellulitis. Further work-up included serologic analysis, auto-immune panel, and MRI. Further imaging showed pseudocystic orbital lesions mimicking orbital cysticercosis. Additionally, given the bilateral nature of the lesions and patient’s country of origin, this parasitic process was highly suspected. A course of albendazole and steroids led to resolution of symptoms. With a presentation at age 30, this is by far the youngest case reported in literature to date.
Trans-Oral Robotic Surgery (TORS) is an alternative surgery technique used to treat head-and-neck cancer. Compared with conventional surgery, robot assistance allows surgeons to operate within areas with restricted access, such as the oropharynx, reducing the operative morbidity, risk of reconstructive surgery and improving patient outcomes. TORS is a challenging procedure, and intra-operative Ultrasound (US) has the potential to improve anatomy visualization to lessen the cognitive load on surgeons. To date, only intra-oral US has been used in exploratory studies, but intra-oral US can interfere with robot tools. In this study, we assess the feasibility of using transcervical 3D US with TORS: we propose to place the US probe on the patient’s neck to evaluate oropharyngeal anatomy intra-operatively. We also perform the first feasibility study of image registration between transcervical 3D US and Magnetic Resonance Imaging (MRI) for the oropharynx. We collected 3D US and MRI data from five healthy volunteers and four patients with oropharyngeal cancer, and we use a semi-automatic MRI-US registration algorithm to estimate an affine transformation between the two image spaces. The average Target Registration Error (TRE) is 8.26 ± 7.41mm for healthy volunteers and 9.63 ± 5.91mm for patients, and our case studies show that image quality is the key factor for good registration. Our work shows that 3D transcervical US has the clinical potential to enable intraoperative oropharynx imaging and interventional MR guidance during TORS.
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