A systematic approach to evaluating Orbital CT imaging when planning orbital decompression surgery.
Author: Malik Moledina
Base Hospital / Institution: Queen Victoria Hospital
ePoster presentation
Abstract ID: 24-449
Purpose
Orbital decompression surgery remains an indication in Graves orbitopathy for optic nerve compression, corneal exposure, proptosis and congestive orbitopathy. The same approaches are now utilised for transorbital access for neurosurgery, including the emerging “transorbital neuroendoscopic surgery” (TONES).
Posterior orbital surfaces and spaces provide considerable room for orbital expansion with the aim of minimising the risks of diplopia, traumatic cranial nerve injury, cerebrospinal fluid leak or intracranial haemorrhage. Pre-operative planning and customisation of both the approach and extent of surgery remains the keystone for minimising such complications. We aim to provide a comprehensive and systematic approach to evaluating pre-operative CT scans for patients undergoing orbital decompression surgery.
Methods
A review of the literature and the author’s experience in performing external and endoscopic decompression surgery were used to produce a comprehensive 18-point checklist for evaluating pre-operative CT for orbital decompression surgery.
Results
CT scans should be evaluated based on clinicopathological considerations ensuring correct diagnosis, excluding co-existing pathology and delineating the extent of orbitopathy. Anatomical variations should then be assessed based on the approach taken (endoscopic or external). The type of decompression performed (fat-removal, medial, lateral, orbital floor or a combination) with particular attention to the following characteristics. Orbital walls and associated structures (ethmoid, lateral wall, floor, fovea ethmoidalis, olfactory fossa and cribiform plate), sinuses with their variants (ethmoid, sphenoid, Haller and Onodi cells) and key vascular (ethmoidal and carotid), nerve (optic and infraorbital) and related structures (middle cranial fossa).
Conclusion
We provide a systematic and comprehensive approach to evaluating pre-operative CT scans for orbital decompression surgery. This helps tailor the procedure to the patient and highlights variations in anatomy to the surgeon, avoiding adverse events.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Bhupendra | Patel | Queen Victoria Hospital |
| Dinesh | Selva | Queen Victoria Hospital |
| Raman | Malhotra | Queen Victoria Hospital |
