The Use of a Computer-Assisted Image-Guided System (InstaTrak) in Orbital Surgery

Camara, Jorge G; Nguyen, Ly; Fernandez-Suntay, Jessica P.; Nardin, George F.; Sua, Alex S.

doi:10.1097/00002341-200111000-00012

Cited by 29 publications

(16 citation statements)

References 7 publications

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“…Computer assisted image-guided systems were introduced in orbital surgery 20 years ago (Klimek et al 1993) and have been used also in endoscopic decompression surgery (Camara et al 2001;Dubin et al 2008;Kent et al 2010). We find it to be a helpful tool particularly when removing the bone close to the outlet of the optic canal.…”

Section: Discussionmentioning

confidence: 96%

Long‐term follow‐up of patients with thyroid eye disease treated with endoscopic orbital decompression

Gulati

Ueland

Haugen

et al. 2014

Acta Ophthalmologica

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ABSTRACT.Purpose: To evaluate the outcome of endoscopic decompression in a series of patients with thyroid eye disease. Methods: All 46 patients operated at our institution in the period 2001 to 2011 were invited for re-examination. Thirty-seven patients were included in the study and underwent a general otorhinolaryngological and ophthalmological examination. Nasal endoscopy, autoperimetry and a CT scan of the orbits and paranasal sinuses were performed. Preoperative and early postoperative data were obtained from hospital records. Re-examination was performed from 12 months to 9 years postoperatively. Paired t-test was used to evaluate the change in pre-and postoperative data. Image-guided surgery was used in two patients. Results: Visual acuity improved from a median value (range) of 0.8 (0.05-1.25) to 1.0 (0.4-1.25) (p = 0.006). Intra-ocular pressure (IOP) was reduced from a median value (range) of 18 mmHg (10-27 mmHg) to 14 mmHg (8-24 mmHg) (p < 0.001). Median (range) Hertel values were 22.5 mm (14-29 mm) preoperatively and 19 mm (11-26 mm) postoperatively (p < 0.001). Mean reduction in proptosis was 4.0 mm. At follow-up, visual fields were normal in 16/37 patients (43%) and with small defects in 12/37 patients (32%). Seventeen patients (46%) had diplopia preoperatively in one or more directions of gaze while 9 (24%) suffered from constant diplopia. After endoscopic decompression, new onset diplopia was seen in seven (19%) individuals, while worsening of diplopia occurred in eight (22%). Impaired motility in abduction and/or elevation was seen in 20 (54%) individuals before decompression and in 23 (62%) after. Strabismus surgery was performed in 22 patients. On final examination 85% of the study population were totally free of diplopia or experienced diplopia only in the peripheral field of gaze. Three patients developed sinusitis. Of these, endoscopic sinus surgery was performed in two patients, and one patient was conservatively treated. Symptoms resolved in all three patients. Conclusion: Endoscopic medial orbital decompression including removal of the medial floor of the orbit is a safe and effective procedure for treatment of thyroid eye disease. Navigation can be of valuable help to ensure complete resection of the bony walls. However, the majority of patients will need subsequent strabismus surgery, mainly due to significant increase of esotropia.

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Section: Discussionmentioning

confidence: 96%

Long‐term follow‐up of patients with thyroid eye disease treated with endoscopic orbital decompression

Gulati

Ueland

Haugen

et al. 2014

Acta Ophthalmologica

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“…[7][8][9][10][11][12][13][14][15][16][17] The general consensus among various studies was that navigation offers certain advantages like good visualization, improved anatomical localization, and allows more aggressive surgery with enhanced safety and good outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14][15][16][17] However, literature is very sparse for lacrimal surgeries with only 3 focused case reports documented in the literature, to the best of author's knowledge. [18][19][20][21] This study propose the term "image-guided dacyo-localization" to encompass the use of stereotactic navigation for lacrimal disorders.…”

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confidence: 99%

Image-Guided Dacryolocalization (IGDL) in Traumatic Secondary Acquired Lacrimal drainage Obstructions (SALDO)

Ali

Naik

2015

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…Several groups reported the successful use of various neuronavigation devices based on preoperatively acquired CT or MRI scans during surgical removal of orbit-associated tumors. 3,7,8,11,13,15,34 Most researchers conclude that the use of image-guided surgery is especially helpful in planning the optimal surgical approach and increasing resection grade independently of the tumor entity 3,15,29 while increasing safety, thus reducing if not completely avoiding operative morbidity.…”

Section: Discussionmentioning

confidence: 99%

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

Terpolilli¹,

Rachinger²,

Kunz³

et al. 2016

JNS

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S kull base tumors with close anatomical association to orbit, optic nerve, and the cavernous sinus often cause neurological symptoms like loss of visual function and exophthalmus. In most cases resection (complete or partial removal) is the most promising and most effective therapeutic approach with regard to preservation or restoration of visual function. Furthermore, operative tumor removal or reduction is a crucial step in multidisciplinary operative as well as medical or radiotherapeutic treatment concepts, because it allows exact histological diagnosis and safe decompression of anatomical structures at risk. However, resection of these tumors is associated with increased perioperative morbidity due to the proximity of highly sensitive structures-e.g., cranial nerves abbreviatioNs CN = cranial nerve; iCT = intraoperative CT; iMRI = intraoperative MRI; NNS = neuronavigational system. obJective Treatment of skull base lesions is complex and usually requires a multidisciplinary approach. In meningioma, which is the most common tumor entity in this region, resection is considered to be the most important therapeutic step to avoid tumor recurrence. However, resection of skull base lesions with orbital or optic nerve involvement poses a challenge due to their anatomical structure and their proximity to eloquent areas. Therefore the main goal of surgery should be to achieve the maximum extent of resection while preserving neurological function. In the postoperative course, medical and radiotherapeutic strategies may then be successfully used to treat possible tumor residues. Methods to safely improve the extent of resection in skull base lesions therefore are desirable. The current study reports the authors' experience with the use of intraoperative CT (iCT) combined with neuronavigation with regard to feasibility and possible benefits of the method. methods Those patients with tumorous lesions in relationship to the orbit, sphenoid wing, or cavernous sinus who were surgically treated between October 2008 and December 2013 using iCT-based neuronavigation and in whom an intraoperative scan was obtained for control of resection were included. In all cases a second iCT scan was performed under sterile conditions after completion of navigation-guided microsurgical tumor resection. The surgical strategy was adapted accordingly; if necessary, resection was continued. results Twenty-three patients (19 with WHO Grade I meningioma and 4 with other lesions) were included. The most common clinical symptoms were loss of visual acuity and exophthalmus. Intraoperative control of resection by iCT was successfully obtained in all cases. Intraoperative imaging changed the surgical approach in more than half (52.2%) of these patients, either because iCT demonstrated unexpected residual tumor masses or because the second scan revealed additional tumor tissue that was not detected in the first scan due to overlay by osseous tumor parts; in these cases resection was continued. In the remaining cases resection was concluded as planned ...

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The Use of a Computer-Assisted Image-Guided System (InstaTrak) in Orbital Surgery

Abstract: The CAIGS (InstaTrak) system is a useful adjunctive tool in providing intraoperative anatomic guidance in a consecutive series of varied orbital operations.

Cited by 29 publications

References 7 publications

Long‐term follow‐up of patients with thyroid eye disease treated with endoscopic orbital decompression

Long‐term follow‐up of patients with thyroid eye disease treated with endoscopic orbital decompression

Image-Guided Dacryolocalization (IGDL) in Traumatic Secondary Acquired Lacrimal drainage Obstructions (SALDO)

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

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