Stereotactic Navigation With a Registration Mask in Orbital Decompression Surgery: Preliminary Results

Frameless stereotactic navigation has been widely adopted in multiple surgical specialties and has been increasingly used by oculoplastic surgeons. The authors report their preliminary results using navigation guidance with a registration mask for orbital decompressions.

Stereotactic navigation with an adhesive autoregistration mask was used to guide consecutive orbital decompression surgeries for Graves' orbitopathy performed by 1 surgeon at the authors' institution from January 2014 to September 2014. Decompressions performed were 1 or 2 sided with medial, lateral, or balanced techniques. Navigation-guided operating technique and operating parameters are reported and compared with non-navigation-guided decompressions performed by the same surgeon in 2013.

Eleven decompressions were performed in 7 patients. The median age of the cohort was 60 years, and 5 patients were female. No intraoperative or late complications occurred with the registration mask or with the navigation system. Although initially longer than in decompressions performed without navigation, actual operating times consistently decreased with each sequential case until they were 8, 40, and 24 minutes shorter than surgeries performed without navigation for balanced, lateral, and medial decompressions, respectively.

An autoregistration mask enables intraoperative navigation guidance that is associated with no complications in this small case series. Benefits include improved anatomical localization and shorter actual operating times after overcoming initial learning curve, especially for lateral wall decompressions. Navigation guidance may be useful for deep orbital procedures. They may also have utility in surgical training. Wider adoption of the technology will be driven by both efficiency and patient safety. Additional studies are warranted.