2025 Proffered Presentations
S302: EVOLUTION OF GLOBE POSITION OVER TIME FOLLOWING LATERAL TRANSORBITAL APPROACHES TO THE MIDDLE CRANIAL FOSSA
Quillan M Austria, MD1; Shanlee M Stevens, MD1; Allison Coombs, DO1; Gary J Lelli, MD1; Theodore H Schwartz, MD2; Kyle J Godfrey, MD1; 1Department of Ophthalmology, Weill Cornell Medicine, New York Presbyterian Hospital; 2Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital
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 (Figure 1). Pre and post operative measurements were compared.
Results: 39 patients met inclusion criteria. Demographics are summarized in Table 1. The preoperative globe position was 20.09±3.1mm. The globe position at first post operative scan, 3-6 month scan, and most recent scan were 20.46±5.4mm, 18.83± 3.1mm and 18.08±4.1mm respectively (Figure 2). The preoperative amount of relative exophthalmos to the nonoperative eye was 1.03±2.5mm. The amount of relative proptosis at first post operative scan, 3-6 month scan, and most recent scan were 2.21±2.6mm, 1.01±4.0mm, and 0.3±1.9mm respectively.
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 post-surgical 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.
References
1. Wnuk E, Maj E, Jablonska-Pawlak A, Jeczen M, Rowinska-Berman K, Rowinski O. Validation of exophthalmos magnetic resonance imaging measurements in patients with Graves' orbitopathy, compared to ophthalmometry results. Pol J Radiol. 2022
Figure 1
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 |
Figure 2.
