The application of stereotactic navigation surgery to orbital decompression for thyroid-associated orbitopathy.

OBJECTIVES

To describe the application of stereotactic guidance, its preoperative workup, and limitations, if any, during orbital decompression surgery of the lateral orbital wall for thyroid-associated orbitopathy (TAO).

METHODS

Case-controlled series of seven patients who underwent stereotactic-guided surgical navigation during external approach balanced orbital decompression with maximal debulking of the lateral wall.

RESULTS

A progressive increase in debulking of the greater wing of sphenoid and exposure of dura was noted in the series. The average proptosis reduction was 9.36 mm. No complications were encountered during any of the cases, nor was there any new onset postoperative diplopia. In all cases, exposure of dura was planned and did not present as a surprise. Stereotactic setup added 10 min to preparation time.

CONCLUSIONS

Stereotactic guidance improves anatomic localization and precision during orbital decompression, increasing confidence, and reducing surgical stress. The ability to accurately determine the maximal limits of decompression real time, while confirming depth of bone removal, offers the possibility of reduced risk of iatrogenic injury. Stereotactic navigation allows for improved intraoperative localization that may improve the ability to maximally decompress the lateral wall, including the zygoma, orbital roof, and trigone, and extending towards the optic nerve with exposure of dura through smaller incisions.