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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

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A novel indicator in evaluating endoscopic orbital decompression for thyroid-associated orbitopathy.

Jieliang Shi¹, Zhaoqi Pan¹, Yunhai Tu¹

¹Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.

Frontiers in Endocrinology

|April 23, 2025

Summary

The increase rate of effective orbital volume (IREOV) effectively measures outcomes after thyroid-associated orbitopathy (TAO) surgery. Medial wall decompression showed higher IREOV than lateral wall decompression, especially in muscle hypertrophy cases.

Keywords:

artificial intelligence technology effective orbital volume lateral wall decompression orbital decompression thyroid-associated orbitopathy

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Area of Science:

Ophthalmology
Medical Imaging
Artificial Intelligence

Background:

Thyroid-associated orbitopathy (TAO) often requires surgical intervention like endoscopic orbital decompression.
Evaluating surgical outcomes, particularly proptosis reduction and orbital volume changes, is critical for patient management.
Novel indicators are needed to accurately assess the efficacy of different decompression techniques.

Purpose of the Study:

To introduce the increase rate of effective orbital volume (IREOV) as a new metric for assessing endoscopic orbital decompression in TAO.
To compare the effectiveness of medial wall decompression (MWD) versus lateral wall decompression (LWD) using IREOV.
To analyze the influence of postoperative extraocular muscle expansion on IREOV.

Main Methods:

A retrospective study involving 69 patients (124 orbits) who underwent MWD or LWD with fat decompression for TAO.
Utilized an Artificial Intelligence OrbitNet system for orbital segmentation and IREOV calculation.
Assessed the impact of postoperative extraocular muscle expansion, categorizing patients into muscle hypertrophy and fat hyperplasia groups.

Main Results:

The average IREOV was 0.14 ± 0.08. Postoperative IREOV was significantly higher following MWD (0.17 ± 0.07) compared to LWD (0.05 ± 0.05) (P<0.001).
Medial rectus muscle expansion significantly impacted IREOV after MWD, while lateral rectus muscle expansion affected IREOV after LWD.
TAO patients with muscle hypertrophy showed higher IREOV after MWD than those with fat hypertrophy (P<0.001). Proptosis reduction was similar between MWD and LWD (P>0.05).

Conclusions:

Accurate IREOV calculation via AI is vital for evaluating orbital decompression efficacy.
For TAO patients with fat hyperplasia, LWD is recommended to minimize extraocular muscle expansion risk.
Postoperative surveillance for extraocular muscle expansion is essential when MWD is performed on patients with fat hyperplasia.