Endoscopic transorbital surgery: a transformative approach to pediatric orbital trauma with functional and structural complications.

The endoscopic transorbital approach (ETA) has emerged as a promising technique in minimally invasive skull base surgery. However, there is limited data on its safety and efficacy in pediatric patients. We operated on pediatric patients with (Cerebrospinal Fluid) CSF leakage, compression of orbital structures and orbital subperiosteal hematoma due to trauma. Patients were operated to eliminate limitation of eye movements, to prevent the persistence of diplopia, to prevent CSF leakage and to reduce proptosis. This study aim to evaluate the feasibility and outcomes of ETA in the surgical treatment of pediatric orbital traumas. The study was designed retrospectively. Pediatric cases who underwent endoscopic transorbital procedures due to trauma between August 2022 and September 2024 were included in the study. Demographic characteristics, surgical process, complications, hospital stay, and ophthalmologic outcomes were reviewed. A standard neuroendoscopic system was used and specific surgical protocols were performed. All patients had orbital fracture and proptosis. Bone compression due to orbital fracture (two cases) and orbital volume reduction due to subperiosteal hematoma (four cases) were the causes of proptosis. Four patients had preoperative CSF leakage. The mean age was 6.6 years and the average surgery duration was 62 min. The mean blood loss was 52 ml. No postoperative deterioration in vision or eye movements was observed. Symptoms such as diplopia, proptosis, and restricted eye movements resolved completely within the first week postoperatively. No postoperative intraorbital infections or significant complications were reported. ETA demonstrates safety and effectiveness in the surgical treatment of pediatric orbital fractures, CSF leakage and orbital hematoma. The primary endpoint of the study was the evaluation of the treatment of the patients' symptoms. In all cases, we found that proptosis and diplopia had completely resolved by the end of the first postoperative month. Minimally invasive nature of ETA, shorter operative times, low complication rates, and rapid recovery highlight its potential as a viable alternative to traditional orbital approaches.