Application of the orbito-cranial approach in pediatric neurosurgery

Objective: This study evaluates the benefits of and indications for the orb ito-cranial approach (OCA) in pediatric patients. Methods and results: The authors report their recent experience of using the OCA in 9 pediatric pati ents, 6 boys and 3 girls. The patients' ages ranged from 3 to 17 years (mea n 9.6 +/-5.16 years). Follow-up periods varied between 6 and 21 months (mea n 12.6 +/-5.9 months). Five patients were operated on for craniopharyngioma s, 2 for chiasmatic-hypothalamic astrocytomas, 1 for a recurrent hypothalam ic gangliocytoma, and 1 for a hypothalamic hamartoma. In 7 cases a neuronav igation system (BrainLab) was utilized. The lesions were removed totally in 5 patients, near-totally in 1, subtotally in 2, and partially in 1 patient . An average increase of 30% in the area of vertical exposure significantly decreased the need for brain retraction. There was no mortality in this se ries. The only complications connected with the surgical approach were tran sient subgaleal cerebro-spinal fluid collections in 7 of 9 children and a s ubgaleal-peritoneal shunt placement in another patient. Conclusions: Our ex perience with this series of patients suggests that the OCA is as safe and beneficial in pediatric patients as it is in adults. It facilitates tumor r emoval by providing, shorter access to and better exposure of the suprasell ar area, thereby minimizing brain retraction.