000			03260nam a22003857a 4500
008			240122s20232023xxu||||| |||| 00| 0 eng d
022			_a2332-4252
024			_a01787389-990000000-00900 [pii]
024			_a10.1227/ons.0000000000000934 [doi]
040			_aOvid MEDLINE(R)
099			_a37815228
245			_aTransorbital Surgical Corridor: An Anatomic Analysis of Ocular Globe Retraction and the Associated Exposure for the Transpalpebral Orbital Rim Preserving Endoscopic Orbitotomy (TORPEDO) Approach.
251			_aOperative Neurosurgery. 2023 Oct 09
252			_aOper Neurosurg (Hagerstown). 2023 Oct 09
253			_aOperative neurosurgery (Hagerstown, Md.)
260			_c2023
260			_fFY2024
260			_p2023 Oct 09
265			_saheadofprint
265			_tPublisher
520			_aBACKGROUND AND OBJECTIVES: The transorbital approach varies by the extent of bony removal and the target. Orbital rim-sparing transorbital approach with removal of only the orbit's posterior wall provides optimal cosmetic results, without the need for reconstruction. The size of this corridor, limited by the medial globe retraction, has not yet been defined and is difficult to determine in cadavers because of postmortem tissue desiccation. By using patient-specific models in virtual reality, precise areas and degrees of surgical freedom (AOF and DOF, respectively) provided by globe retraction were calculated. These measurements define a potential maximum safe AOF and DOF, as well as the globe retraction, needed to achieve a sufficient surgical corridor.
266			_d2024-01-22
520			_aCONCLUSION: Globe retraction of 11 mm is needed to achieve sufficient DOF for 2 surgical instruments, and 15 mm of retraction is a conservative limit that provides comparable AOFs with similar cranial approaches. Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
520			_aMETHODS: Using a virtual reality system, transorbital rim-preserving craniectomies were performed. The axial and sagittal DOF as well as AOF were calculated lateral to the globe, limited by the orbital rim and globe, with an anterior clinoid target. The DOFs and AOFs were calculated for each degree of medial globe retraction and analyzed using paired t tests.
520			_aRESULTS: With only 5 mm of retraction, the AOF was 886 mm2, while at 10 mm, the AOF was 1546 mm2. This increase between 5 and 10 mm allowed for the largest increase in surgical working corridor (P = .02). At 15 mm of retraction (previously studied point at which intraocular pressure raises), the AOF averaged 2189 mm2 and axial DOF averaged 23.1degree. Eighteen DOF (a previously studied point needed to achieve sufficient working space for 2 instruments) was achieved at 11 mm on average, generating 1675 mm2 AOF.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Washington Hospital Center
656			_aNeurosurgery
657			_aJournal Article
700			_aFelbaum, Daniel _bMWHC
790			_aPiper K, Saez-Alegre M, George Z, Srivastava A, Felbaum DR, Jean WC
856			_uhttps://dx.doi.org/10.1227/ons.0000000000000934 _zhttps://dx.doi.org/10.1227/ons.0000000000000934
942			_cART _dArticle
999			_c13888 _d13888