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

Abstract

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.

Evaluation of Surgical-Navigation System in Management of Orbital Disorders

“…This warranted the repositioning of the field generating magnet so that the computer system automatically could detect the instrument in use. Our conclusion was the same as Lee, Miller et al, who found that commonly encountered disadvantages of surgical navigation include learning curve, machine setup times, expense and equipment availability [6,7] .…”

Surgical management of temple-related problems following lateral wall rim-sparing orbital decompression for thyroid-related orbitopathy

“…Additional retroplacement of the globe can be achieved by combining the latter approach with intraorbital fat decompression 18. Stereotactic-guided navigation has been shown to be an asset in achieving safe and effective decompression of the deep lateral wall but is currently limited by its cost and availability 19 20…”

Orbital decompression in thyroid eye disease

“…Whether stereotactic navigation in decompression surgery as described by Miller and Maloof [53] offers significant advantages remains to be proven. [22] the futility of attempting to remove masses of orbital fat has been proved ever since the account published by von Graefe in 1864.…”