Exclusively endoscopic endonasal resection of benign orbital tumors: a systematic review and meta‐analysis

Abstract

BackgroundThe Cavernous Hemangioma Exclusively Endonasal Resection CHEER classification system was developed to standardize prospective outcome analysis following orbital cavernous hemangioma OCH resection The goal of this study was to retroactively apply the CHEER system to all prior existing reports of endoscopic resection of primary benign orbital tumors BOTs to compare patient presentations perioperative characteristics and outcomes between OCH and other BOTs and determine whether the CHEER categorization regime could be expanded to other BOTs Methods A systematic review of studies reporting exclusively endoscopic resections of OCH and other BOTs eg solitary fibrous tumor schwannoma and meningioma was performed Patient tumor characteristics and operative outcomes were recorded All tumors with adequate reporting were retrospectively assigned a CHEER stage Outcomes were compared using chi-square or Fisher's exact tests Results Ninety-three studies met inclusion criteria and sufficient data were available in studies comprising tumors n =OCHs n = other BOTs Baseline patient and tumor characteristics as well as intraoperative and short-term postoperative outcomes were not signifi-cantly different between OCHs and other BOTs Long-term outcomes eg visual deficits diplopia eye position and recurrence also did not differ when controlling for CHEER stage Conclusion This review represents the largest collection of outcomes data following exclusively endoscopic endonasal resection of BOTs Short-term and long-term outcomes appear similar between OCHs and other BOTs These results suggest that exclusively endoscopic resection of orbital tumors may be effective in a range of benign pathologies Furthermore these results support a broader application of the CHEER system to other benign primary orbital tumors

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

“…A systematic review of studies reporting exclusively endoscopic endonasal resections of primary BOTs was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines as previously described by Jafari et al 4 The results from the original search were uploaded to Covidence systematic review software (Covidence) for independent screening, multiphase review, and data extraction. Studies that did not include reporting of at least one EER for a BOT, abstracts without available full texts, review articles, cases of malignant tumors or metastases (as such lesions often have different operative characteristics and varying surgical goals), nonexclusively endoscopic cases, non‐English language articles, and articles not reporting reconstruction status were excluded.…”

“…The previously developed Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) system 11 (the application of which has been broadened to other BOTs as well) 4 was used to assign a stage to each tumor based on the imaging and location reported by the author(s) of each study. If there were insufficient data to determine the location of the tumor, these data were excluded for that tumor.…”

“…With recent innovations in skull base and sinonasal surgery, the use of exclusively endonasal resection (EER) for orbital tumors is increasing 1–4 . This is especially the case for benign orbital tumors (BOTs), which are commonly encapsulated and are, thus, more amenable to EER 4,5 .…”

“…With recent innovations in skull base and sinonasal surgery, the use of exclusively endonasal resection (EER) for orbital tumors is increasing. 1 , 2 , 3 , 4 This is especially the case for benign orbital tumors (BOTs), which are commonly encapsulated and are, thus, more amenable to EER. 4 , 5 Compared to external approaches, the transnasal approach to EER of BOTs provides enhanced visualization and illumination while limiting postoperative morbidity by minimizing intraoperative retraction and trauma to surrounding structures.…”

“… 1 , 2 , 3 , 4 This is especially the case for benign orbital tumors (BOTs), which are commonly encapsulated and are, thus, more amenable to EER. 4 , 5 Compared to external approaches, the transnasal approach to EER of BOTs provides enhanced visualization and illumination while limiting postoperative morbidity by minimizing intraoperative retraction and trauma to surrounding structures. 5 , 6 The EER approach may, however, necessitate removal of large portions of orbital bone and periorbita, significant extraocular muscle (EOM) retraction, and intranasal exposure of intraconal structures, 6 , 7 —all of which may contribute to untoward postoperative morbidity.…”