갑상선 눈병증에서 안와 감압술시 정위적 수술항해 장치의 효과
Evaluation of Stereotactic Navigation During Orbital Decompression in Thyroid-Associated Orbitopathy Patients
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목적: 수술항해 장치를 이용한 정위적 수술이 갑상선 눈병증 환자에서 안와 감압에 어떤 효과를 미치는지 알아보고자 하였다. 대상과 방법: 갑상선 눈병증으로 안와 감압술을 시행 받은 환자 27명 48안을 대상으로 후향적으로 연구하였다. 15명 28안은 수술항해장치를 사용하였고 12명 20안은 수술 항해장치를 사용하지 않았다. 컴퓨터 전산화 단층촬영을 통해 수술 후 내벽, 외벽, 하벽의 안와감압부피를 구하고 안구의 수평, 수직 편위의 변화를 분석하여 두군에서 비교하였다. 결과: 수술항해 장치를 사용한 군에서 대조군에 비하여 유의하게 외벽 감압량이 많은 것으로 나타났다(p＜0.05, p=0.025). 하지만 내벽및 하벽 감압량은 두 군간에 유의한 차이를 보이지 않았다. 안구의 수평 및 수직 편위 변화량 역시 두 군간에 유의한 차이를 보이지않았다. 수술 후 컴퓨터 전산화 단층촬영 소견 상 뇌경막이나 대뇌실질의 손상이 의심되거나 신경과적 합병증을 보인 환자는 없었다. 결론: 안와 외벽 감압술 시 수술항해 장치를 사용하면 술자가 안전하게 더 많은 양의 안와골을 효과적으로 감압할 수 있다.
Abstract
Purpose: To evaluate the use of stereotactic navigation during orbital decompression surgery. Methods: We conducted a retrospective analysis of 27 patients (48 orbits) with thyroid-associated orbitopathy who underwentorbital decompression. Stereotactic navigation was performed on 28 orbits of 15 patients, and orbital decompressionsurgery without navigation was performed on 20 orbits of 12 patients. The changes in medial wall, lateral wall and inferiorwall orbital volume in CT scans and horizontal and vertical eyeball deviation after surgery were analyzed in the 2 patientgroups. Results: The mean decompressed volume of orbits was significantly increased in the lateral wall decompression with stereotacticnavigation patient group than without stereotactic navigation (p < 0.05, p = 0.025). However, in the inferior walland the medial wall decompression, there was no significant difference between the 2 groups. The changes of horizontaland vertical deviation were not significant between the 2 groups and no patient experienced neural damage. Conclusions: The stereotactic navigation during lateral orbital wall decompression is a safe and effective method for inducinggreater decompressed volume.
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