Frontotemporal-orbitozygomatic approach for pediatric cranio-orbital tumors: a single-center experience.

OBJECTIVE

To evaluate the surgical anatomy, technical nuances, and early postoperative outcomes of the frontotemporal-orbitozygomatic (FTOZ) approach in a consecutive series of pediatric cranio-orbital communicating tumors. To evaluate the surgical anatomy, technical nuances, and early postoperative outcomes of the frontotemporal-orbitozygomatic (FTOZ) approach in a consecutive series of pediatric cranio-orbital communicating tumors. Unilateral Dodge Class I Optic Pathway Glioma without Neurofibromatosis Type 1 (OPG-uDCI) was selected as an index pathology to illustrate the specific application of this approach in a representative subgroup.

METHODS

Thirteen children (five female, eight male) with imaging and histopathology confirmed cranio-orbital communicating tumours were managed at a single institution from April 2020 to August 2024.

RESULTS

At operation, the median age was 24 months (interquartile range 4-156 months). Postoperative surveillance extended for a median of 21 months (interquartile range 9-62 months). Notably, 10 patients had a follow-up period of at least 12 months. Histopathological diagnoses included: OPG, rhabdomyosarcoma, mature teratoma, optic nerve sheath meningioma, langerhans cell histiocytosis, and ewing-like sarcoma. Surgical complications included one case of severe postoperative chemosis with corneal ulceration requiring enucleation and one wound infection. There were no operative mortalities in this series. During follow-up, no patients with OPG demonstrated contralateral visual field changes postoperatively. Among the seven participants in whom macroscopic total excision was accomplished, neoplastic relapse subsequently developed in three.

CONCLUSIONS

The FTOZ approach is a technically feasible corridor for resection of pediatric cranio-orbital tumors in selected cases. However, given the small sample size, short follow-up, and occurrence of major complications, these findings should be considered preliminary. Definitive conclusions regarding safety and efficacy await larger comparative studies.