Stereotactic microdebrider in deep lateral orbital decompression for patients with thyroid eye disease.
OBJECTIVE
Stereotactic navigation systems have been used in neurosurgery and otolaryngology with great success. The current investigation illustrates the novel use of a microdebrider with built-in stereotactic guidance in a series of thyroid orbitopathy patients who underwent deep lateral orbital wall decompression surgery.


METHODS
A noncomparative, interventional, retrospective case series of patients who underwent deep lateral deep orbital wall decompression from 2006 to 2013 was conducted in accordance with Institutional Review Board policy and the Declaration of Helsinki. Patient demographics, indications for surgery, pre-, intra-, and postoperative findings along with complications were recorded.


RESULTS
One hundred eight deep lateral orbital decompression surgeries were performed in 69 patients using the Straightshot M4 Microdebrider with built-in stereotactic guidance (Medtronics). Seventy-eight cases were in women and 30 cases were in men. The average age was 50.4 years (SD = 11.9 years). Indications for surgery included proptosis, exposure keratopathy, or compressive optic neuropathy. No patient experienced intraoperative complications. Specifically, cerebrospinal fluid leak, visual loss, infection, or unanticipated inflammation were not encountered. The average postoperative follow-up time was 5.35 months. Mean reduction in proptosis was 3.72 mm (SD = 2.1). Visual acuity improved in 32.4% (35/108) of cases.


CONCLUSIONS
This surgical instrument combines a single handpiece locator, microdebrider, irrigator, retractor, and suction device into one. It enhances anatomical localization during orbital decompression and, with an integrated tissue guard, may decrease the risk of injury to orbital soft tissues. Stereotactic navigation enhances the surgeon's ability to determine the maximal limits of decompression in real time by confirming depth of bone removal and may potentially increase surgeons' confidence in orbital decompression surgery.
*Department of Ophthalmology, West Virginia University, Morgantown, West Virginia; †Department of Ophthalmology, Harvard Medical School; ‡Ophthalmic Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary; §Department of Otology and Laryngology, Harvard Medical School; and ‖Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
John
J
Nguyen
Aaron
A
Fay
Prashant
P
Yadav
Peter W
PW
MacIntosh
Ralph
R
Metson
D000328:Adult; D000368:Aged; D003646:Debridement / Q000295:instrumentation*; D019299:Decompression, Surgical / Q000379:methods*; D005094:Exophthalmos / Q000601:surgery; D005141:Eyelid Diseases / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000601:surgery; D009915:Orbit / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult