Cranio-Orbital Oncoplastic Reconstruction in Pediatric Population: Single-Institution’s Experience of 10 Cases

Abstract

Background: Pediatric cranio-orbital tumors have several etiologies and given the broad spectrum of pathology, it is difficult to predict the extent of resection. Reconstruction in children and adolescents is particularly challenging due to potential craniofacial growth and the relatively limited availability of donor sites. In this review, we analyze 10 pediatric and adolescent cases from a single institution, discuss the existing literature, and propose a reconstruction algorithm for managing these complex defects. Methods: A retrospective chart review was performed to identify pediatric and adolescent patients with cranio-orbital tumors who underwent tumor resection and reconstruction at our institution between January 2012 and July 2022. Results: A total of 10 patients underwent oncoplastic reconstruction of defects of either the cranium alone or combination of cranium and orbit, with a mean age of 12.4 years (range: 2-20). The defects involved the parietal (n = 3, 30%), parietooccipital (n = 1; 10%), temporoparietal (n = 1; 10%), occipital (n = 1, 10%), and fronto-orbital (n = 4; 40%) regions. Cranioplasty was performed with split-thickness bone grafts, exchange cranioplasty, or alloplastic materials. A pericranial flap was used to isolate intracranial and extracranial contents in 2 cases. Free flaps were utilized for additional soft tissue coverage in 2 cases. Complications included free flap venous thrombosis, CSF leak, hardware exposure, sagittal sinus injury, superior sagittal sinus thrombosis, vertical diplopia, and hypertropia. Conclusion: The goals of oncoplastic reconstruction for cranio-orbital defects in pediatric and adolescent patients align with those in adults. However, reconstructive surgeons must consider age-specific differences, such as growth potential and limited donor sites. Effective reconstruction can be achieved through meticulous planning, clear communication, and a multidisciplinary approach.