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Do Minimally Invasive Approaches to Pediatric Orbital Tumors Provide an Advantage on Outcome and Efficiency?
Luca Massimi1, Grazia Menna2, Paolo Frassanito2
1Pediatric Neurosurgery-Department of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
Minimally invasive surgery for pediatric orbital lesions significantly improves surgical, clinical, and cosmetic outcomes. These approaches reduce complications, pain, and costs compared to traditional methods, offering better results for children.
Area of Science:
- Pediatric Ophthalmology
- Neurosurgery
- Surgical Oncology
Background:
- Orbital lesions in children present unique surgical challenges.
- Traditional invasive approaches may lead to significant morbidity.
- Evaluating minimally invasive techniques is crucial for optimizing pediatric care.
Purpose of the Study:
- To compare surgical, clinical, and aesthetic outcomes of minimally invasive versus traditional surgical approaches for orbital lesions in children.
- To establish the safety and efficacy of less invasive techniques in pediatric orbital surgery.
Main Methods:
- A retrospective analysis of 30 pediatric patients with orbital lesions operated between 2010 and 2020.
- Patients were divided into two groups: traditional surgical approaches (Group A, n=14) and minimally invasive approaches (Group B, n=16).
- Outcomes assessed included surgical time, complications, procedure cost, postoperative pain, hospitalization, and cosmetic results.
Main Results:
- Minimally invasive approaches (Group B) showed significantly reduced surgical time, procedure costs, and lower rates of periorbital edema and dural tears compared to traditional methods (Group A).
- Postoperative pain scores and mean hospitalization time were significantly lower in Group B.
- Cosmetic outcomes, assessed by the Sloan classification, were significantly better in the minimally invasive group (81% Class I vs. 36% Class I).
Conclusions:
- Minimally invasive surgical approaches offer significant advantages for treating pediatric orbital lesions, improving surgical, clinical, and cosmetic outcomes.
- These techniques should be preferred when feasible for pediatric orbital tumors.
- Craniotomy remains essential for managing very large tumors.
Objective:
The present study evaluated 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.
Methods:
Children 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.
Results:
There were no significant differences between the 2 groups in terms of demographic data and extent of tumor resection. Mean surgical time for the approach (40 minutes vs. 70 minutes, 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. Regarding clinical outcomes, group B showed a significant reduction both in terms of postoperative 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 cosmetic outcome according to the Sloan classification was significantly better in group B as well (81% vs. 36% class I patients, P = 0.005).
Conclusions:
The use of mini-invasive approaches to orbital tumor has clear advantages in terms of surgical, clinical, and cosmetic outcomes in comparable patients; therefore, they should be preferred whenever feasible. Craniotomic approaches remain necessary for very large tumors.
