Trudi Stereotactic Navigation System for Orbital Decompression Surgery: A Case Series

Introduction: Orbital decompression surgery still plays an important role in the management of thyroid eye disease (TED) refractory to medical management, particularly for patients with proptosis, optic neuropathy, or exposure keratopathy. Intraoperative use of image-guided navigation systems improves precision and minimize complications during these complex procedures, and we herein describe the utilization of the TRUDI stereotactic navigation system, released in 2018, which has several potential advantages including the design of the field generator as a pillow, the lack of adhesive skin markers, and AI powered anatomical alerts. 1–4 This case series is the first to describe the use of TRUDI system versus the prior established StealthStation navigation system in orbital decompression for refractory TED. 2 Methods: A single-center, surgeon group retrospective chart review was performed on TED patients who underwent orbital decompression with StealthStation (Medtronic, Minneapolis, MN) or TRUDI (Acclarent, Irvine, CA) navigation system in 2025. Indications were proptosis, lagophthalmos, and exposure keratoconjunctivitis. Patients with previous orbital or eyelid surgeries were excluded. Data reviewed included patient characteristics, surgical characteristics, and clinical outcomes at minimum of 1-month post-op. Results: The sample consisted of 10 patients, 80.0% female with mean age of 50 years. A total of 7 orbital decompression cases utilized the StealthStation while 8 cases utilized the TRUDI. Additionally, 62.5% of StealthStation and 57.1% of TRUDI cases were smokers, 37.5% of StealthStation and 28.6% of TRUDI cases had diabetes, and 37.5% of StealthStation and 42.9% of TRUDI cases had hypertension. Mean pre-operative exophthalmometry was 23.9mm for both groups, and average post-operative exophthalmometry was 21.7mm in the StealthStation Group and 21.8mm in the TRUDI group. TRUDI assisted surgeries had slightly shorter operative times (M=105, SD=25 minutes) than Stealth assisted surgeries (M=116, SD=29). No patients in either group experienced any intra-operative or immediate post-operative complications. Discussion: The TRUDI navigation system provides a simplified, more efficient workflow compared with StealthStation, which may improve surgeon efficiency and reduce operative time. Shorter operative time and reduced time under anesthesia can decrease risk of complications, operative costs, and improve patient outcomes. The current case series is limited by small sample size and additional research is needed to validate these findings on the benefit of TRUDI in orbital decompression surgery. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany