CURRENT CONCEPTS IN ORBITOTOMY FOR ORBITAL NEOPLASMS: A SCOPING REVIEW

Background: Orbital tumors encompass a heterogeneous group of benign and malignant lesions, requiring complex surgical management due to the confined orbital anatomy and proximity to critical neurovascular structures. Advances in orbitotomy techniques, including minimally invasive and endoscopic approaches, have enhanced surgical outcomes. 

Objective: To systematically review and synthesize the current evidence on orbitotomy approaches for neoplastic orbital lesions, emphasizing indications, anatomical considerations, surgical techniques, and clinical outcomes. 

Methods: A PRISMA-guided systematic review was conducted. PubMed, Scopus, and Web of Science were searched for studies published up to 2025, using terms including orbitotomy, orbital tumors, lateral orbitotomy, endoscopic orbital surgery, and orbital apex lesions. Clinical studies, systematic reviews, and technical reports reporting surgical approaches and outcomes were included. Non-English studies, case reports with fewer than five patients, and studies lacking outcome data were excluded. Data extracted encompassed tumor type, location, surgical approach, complications, and outcomes. 

Results: Forty-six studies met inclusion criteria. Tumor location relative to the optic nerve and orbital compartments determined approach selection. Anterior orbitotomy was most effective for superficial anterior lesions, lateral orbitotomy remained standard for lateral intraconal and lacrimal gland tumors, and medial endoscopic approaches facilitated access to medial and orbital apex lesions with reduced morbidity. Inferior orbitotomy and transmaxillary approaches addressed inferior orbital tumors, while transcranial approaches were reserved for complex apex or intracranial involvement. Integration of endoscopic assistance, intraoperative navigation, and three-dimensional surgical planning improved surgical precision, functional outcomes, and cosmetic results. Anatomy-driven, individualized approaches consistently demonstrated high rates of visual preservation and low complication rates. 

Conclusion: Modern orbital tumor surgery is increasingly anatomy-driven and minimally invasive. Tailored orbitotomy selection, guided by precise tumor localization and supported by advanced imaging, optimizes functional and aesthetic outcomes while minimizing morbidity. Standardized prospective studies are needed to further validate optimal surgical strategies.