Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta‐analysis

Abstract

Objective As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread, high‐quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection. The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices. Methods Data Sources: PubMed, EMBASE, Web of Science. A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted. Articles not reporting orbital reconstruction details were excluded. Patient and tumor characteristics, operative details, and outcomes were recorded. Variables were compared using χ 2 , Fisher's exact, and independent t tests. Results Of 60 patients included from 24 studies, 34 (56.7%) underwent orbital reconstruction following resection. The most common types of reconstruction were pedicled flaps ( n = 15, 44.1%) and free mucosal grafts ( n = 11, 32.4%). Rigid reconstruction was uncommon ( n = 3, 8.8%). Performance of orbital reconstruction was associated with preoperative vision compromise ( p < 0.01). The tendency to forego orbital reconstruction was associated with preoperative proptosis ( p < 0.001), larger tumor size ( p = 0.001), and operative exposure of orbital fat ( p < 0.001) and extraocular muscle ( p = 0.035). There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short‐ or long‐term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short‐term postoperative diplopia when reconstruction was foregone ( p = 0.041). This potential benefit of reconstruction did not persist: At an average of two years postoperatively, all patients for whom reconstruction was foregone either had improved or unchanged diplopia. Conclusion Most outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well‐selected by surgeons in the reported cases included in this systematic review.

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

“…In patients with intraconal tumors, there was a lower rate of short‐term postoperative diplopia when reconstruction was performed (7.4% vs. 31.3%; p = 0.041). Nevertheless, at an average of 2 years postoperatively, this potential benefit of reconstruction did not persist, and the diplopia either improved or remained unchanged for all patients for whom reconstruction was foregone 940 . A trend toward reconstruction for higher CHEER stages was reported in numerous studies 911,915,940 …”

“…Nevertheless, at an average of 2 years postoperatively, this potential benefit of reconstruction did not persist, and the diplopia either improved or remained unchanged for all patients for whom reconstruction was foregone 940 . A trend toward reconstruction for higher CHEER stages was reported in numerous studies 911,915,940 …”

Orbital resection by intranasal technique (ORBIT): A new classification system for reporting endoscopically resectable primary benign orbital tumors

“…Since its introduction, the CHEER framework (stages I-Vb) has become the gold standard in endoscopic endonasal orbital surgery outcomes reporting and has allowed for large-scale data aggregation and meaningful outcomes analyses. [7][8][9][10] In addition to OCHs, other primary benign orbital tumors (PBOTs), such as solitary fibrous tumors and schwannomas, have increasingly been reported to be addressed endonasally with similar success. 7,9,11 This represents a natural extension of the surgical principles gained from OCH surgery, because PBOTs also tend to be well-encapsulated neoplasms.…”

“…This anatomic‐based framework, which was developed in collaboration with an international and multidisciplinary panel of experts, reflects the differential complexity of endoscopic endonasal surgical removal of orbital cavernous hemangiomas (OCHs) by site of origin. Since its introduction, the CHEER framework (stages I–Vb) has become the gold standard in endoscopic endonasal orbital surgery outcomes reporting and has allowed for large‐scale data aggregation and meaningful outcomes analyses 7–10 …”