Do Minimally Invasive Approaches to Pediatric Orbital Tumors Provide an Advantage on Outcome and Efficiency?

Abstract

ObjectiveThe present study aims at evaluating whether minimally invasive approaches to orbital lesions could improve surgical, clinical, and aesthetic outcomes compared with more invasive ones. This is the first study specifically addressing this topic in children. MethodsChildren consecutively operated on from January 2010 to January 2020 were analyzed. Thirty patients matched the inclusion criteria and were divided into Group A: 14 cases, treated with traditional surgical approaches; and Group B: 16 cases, managed by minimally invasive approaches. ResultsThere were no significant differences between the two groups in terms of demographic data and extent of tumor resection. Mean surgical time for the approach (40 min vs 70 min, p < 0.0001), surgical complication such as periorbital edema (37% vs 78%, p = 0.02) and dural tear (0 vs 21%, p = 0.05), and procedures cost (p < 0.0001) were significantly reduced in Group B. About clinical outcomes, Group B showed a significant reduction both in terms of post-operative pain (mean score based on visual pain scale was 2.9 vs 4.1 p = 0.003) and mean hospitalization time (4.5 days vs 5.5 days, p = 0.0004). The aesthetic outcome according to Sloan’s classification was significantly better in Group B as well (81% vs 36% class I patients, p = 0.005). ConclusionThe use of mini-invasive approaches to orbital tumor has clear advantages in terms of surgical, clinical, and aesthetic outcomes in comparable patients; therefore they should be preferred whenever feasible. Craniotomic approaches remain necessary for very large tumors.