Image-guided navigation in posterior orbital tumour surgery: a comparative cohort study

Area of Science:

• Ophthalmology
• Neurosurgery
• Medical Imaging

Background:

• The posterior orbit contains critical neurovascular structures often compromised by tumors.
• Tumor distortion of the posterior orbit presents surgical challenges for localization and access.
• Image-guided navigation (IGN) offers potential for precise localization and reduced collateral damage.

Purpose of the Study:

• To assess the feasibility, effectiveness, and safety of electromagnetic image-guided navigation (IGN) in posterior orbital tumor surgery.
• To compare outcomes of IGN-assisted surgery with a retrospective cohort of non-IGN surgeries.
• To evaluate the impact of IGN on surgical approach, objectives achievement, and complication rates.

Main Methods:

• A comparative cohort study design was employed.
• Electromagnetic IGN was utilized for posterior orbital tumor excision.
• Outcomes were compared between a prospective IGN group and a retrospective non-IGN group.

Main Results:

• IGN integration was feasible without workflow disruption.
• IGN facilitated a shift towards minimal access incisions (transcutaneous lid and transconjunctival) over lateral orbitotomies (93% vs 53%, p=0.009).
• Surgical objectives were achieved in 100% of IGN cases, eliminating the need for revision surgery (vs 23% in non-IGN, p=0.005), with no significant difference in complications.

Conclusions:

• Image-guided navigation (IGN) is a feasible and effective tool for posterior orbital tumor surgery.
• IGN enables consistent achievement of surgical objectives and supports minimally invasive approaches.
• Further multicenter studies are warranted to explore the broader potential of IGN in orbital surgery.