Introduction: The lateral transorbital approach is a minimally invasive, endoscope-assisted approach
for accessing skull base pathology in the middle cranial fossa. Immediate postoperative
globe position in patients undergoing transorbital approaches has previously been
reported in the literature. However, there have not been studies on the evolution
of globe position over time in the postoperative period.
Methods: A retrospective consecutive case review was performed. Included subjects underwent
combined multidisciplinary transorbital approaches with oculoplastic and neurological
surgery at a single-center between 2016 and 2024. Globe positions were assessed by
analyzing orbital or brain magnetic resonance imaging (MRI) according to methods derived
by Wnuk et al.1 MR images were evaluated at times of preoperative scan, first postoperative scan,
three to six months postoperative scan, and most recent scan. Globe position measurements
were taken on T2 fat saturated axial scans, when available, at the level of the lens.
The anterior distance between the interzygomatic line and anterior globe was determined
([Fig. 1]). Pre and post operative measurements were compared.
Fig. 1
Results: A total of 39 patients met inclusion criteria. Demographics are summarized in [Table 1]. The preoperative globe position was 20.09 ± 3.1 mm. The globe position at first
post operative scan, 3- to 6-month scan, and most recent scan were 20.46 ± 5.4 mm,
18.83 ± 3.1 mm and 18.08 ± 4.1 mm, respectively ([Fig. 2]). The preoperative amount of relative exophthalmos to the nonoperative eye was 1.03 ± 2.5
mm. The amount of relative proptosis at first postoperative scan, 3- to 6-month scan,
and most recent scan were 2.21 ± 2.6 mm, 1.01 ± 4.0 mm, and 0.3 ± 1.9 mm, respectively.
Fig. 2
Table 1 Demographics
|
n
|
39
|
|
Mean age (years)
|
53.2 ± 19.7
|
|
Female (%)
|
61.5
|
|
Caucasian (%)
|
89.6
|
|
Fat graft reconstruction (%)
|
89
|
|
Follow-up (weeks)
|
52.19 ± 31.8
|
Conclusion: To the best of the authors’ knowledge, this is the first study assessing the evolution
of postoperative globe position over time in patients undergoing transorbital approach
to neurosurgery. Overall, there was a decrease in relative exophthalmos in the operative
eye compared to the nonoperative eye and improvement in globe symmetry over time.
There was an initial increase in proptosis relative to the nonoperative eye at the
time of first postoperative scan which could be due to postsurgical inflammation that
resolves over time resulting in improved symmetry. Additionally, given that all but
five of these patients underwent orbital reconstruction with autologous fat graft
implantation, the authors hypothesize that the continued decrease in proptosis relative
to the nonoperative eye and improved symmetry in the months following surgery is a
result of fat graft absorption. Further studies with increased patient numbers and
dedicated analysis of fat graft volume over time are necessary to support these findings.
