Are there predictive factors of complications of surgery for benign orbital tumors? A systematic review.

Introduction: Benign tumors account for 64-68 % of orbital tumors, with a wide variety of etiologies. The indication for surgical resection of a benign tumor is not systematic and depends mainly on the functional and esthetic clinical consequences. Surgical management presents risk of serious complications which can lead to major functional disorders and even blindness. The aim of this review is to identify the potential predictive factors of complications in benign orbital tumor surgery and assist therapeutic decision-making.

Material and methods: A systematic review was performed, by searching on PubMed for articles published from January 2000 to July 2023 on surgical management in benign intraorbital tumors and their complications.

Results: Of the 231 studies identified, 15 studies were included with 331 patients, including 183 cavernous hemangiomas, 52 dermoid cysts and 32 schwannomas. The main initial symptoms were exophthalmos or proptosis (83.3 %), decreased vision (21.9 %), and diplopia (11.6 %). 169 intraconal tumors, 50 extraconal tumors and two both intra and extraconal tumors were reported. Most of the studies reported a transconjunctival or transpalpebral approach (72.2 %). The included studies described 87 postoperative complications: severe postoperative visual deterioration (SPVD) (1.2 %), enophthalmos, transient diplopia, and ptosis.

Discussion: This risk of SPVD seems increased in schwannomas and intraconal tumors, especially those close to the orbital apex. The intraconal location is also a risk factor for other complications (diplopia, enophthalmos, ptosis). Nevertheless, it cannot be concluded on the role of the surgical approach on the risk of complications.