Evaluation of Surgical-Navigation System in Management of Orbital Disorders

Abstract
Background: Surgical navigation guidance is primarily designed to assist with surgery on bony tissues and closed spaces, it is widely used in neurosurgery and sinus surgery. And since the limited mobility of the soft tissues of the orbit, as they are tightly contained within its bony walls, stereotactic navigation may be a useful tool in orbial surgeries such as tumor excisions, biopsies, orbital wall fractures, and orbital decopmression.
Aim of Study: To evaluate whether the use of Frameless surgical navigation is useful and time efficient in removing orbital masses and repairing orbital wall fracture as known to be a helpful tool in Neurosurgery and sinus surgery.
Patients and Methods: Prospective interventional non-controlled non-randomized case series study was coducted in Cairo Univeristy Hospitals from June 2013 to December 2014 on 15 patients with primary or recurrent post-septal orbital pathology using the Electromagnetic “FusionTM ENT Naviga-tion System” during the surgery. Primary outcomes were assessing time efficiency through operative times (Total Time, Operating Time and Maintenance Time), extent of mass excision and fracture repair. Secondary outcomes were im-provement in Hertel's readings and detecting complication related to the navigation system.
Results: The mean of maintenance time percentage com-pared to the total operating time was 46.7% with SD ±6.1 that lead to relatively longer total operating time, but as more cases were performed, it decreased gradually. Complete excision was achieved in 70% of cases. The p-value for improved Hertel's reading was 0.016 and only one case had significant complications.
Conclusion: Although promising results were seen in orbital wall fracture and well circumscribed orbital masses. The Surgical Navigation System cannot yet be considered the standard of care for patients with different orbital pathologies as it prolongs the total operating time. However, it is helpful and promising in complicated cases of recurrent and infiltrative masses and massive trauma, where the normal anatomical landmarks are compromised specially with the evolving updates in improving this technology.