Minimally invasive supraorbital keyhole approach in childhood: clinical experience and outcomes of two tertiary centers.

Authors

Umit Eroglu, Luca Massimi, Murat Buyuktepe, Ozan Tekneci, Siavash Hasimoglu, Paolo Frassanito, Gabriele Olivieri, Mustafa Agahan Unlu, Gokmen Kahilogullari

Published in

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. Volume 42. Issue 1. Jun 15, 2026. Epub Jun 15, 2026.

Abstract

The supraorbital keyhole approach via transciliary incision represents a minimally invasive surgical corridor that is increasingly applied in pediatric neurosurgery; however, large childhood-specific series remain scarce. This study reports our two-center experience with this approach in a heterogeneous pediatric population.
A retrospective analysis was performed of all pediatric patients who underwent surgery via the supraorbital keyhole approach through a transciliary incision at Ankara University and Rome Catholic University between 2017 and 2024. Patient demographics, pathological diagnoses, extent of resection, complications, and clinical outcomes were recorded. The extent of resection was classified as gross total resection (GTR), subtotal resection (STR), or near-total resection (NTR) based on the postoperative MRI findings.
Twenty-six patients (mean age, 8.7 years; range, 0.7-17 years) were included in the study. The pathologies included craniopharyngioma (n = 5), cavernous malformation (n = 4), optic pathway glioma (n = 3), pilocytic astrocytoma (n = 2), epidural hematoma (n = 2), frontal abscess (n = 2), and other lesions (n = 8). Among the 20 patients with discrete resectable lesions, GTR was achieved in 11 (55%), STR in six (30%), and NTR in three (15%). Complications occurred in eight patients (30.8%), including transient diabetes insipidus in four, permanent panhypopituitarism in one, permanent diabetes insipidus in one, postoperative epidural hematoma in one, and visual deterioration in one patient. Permanent morbidity was observed in three patients (11.5%). There was no mortality.
The supraorbital keyhole approach via a transciliary incision is a technically feasible and applicable minimally invasive surgical corridor in the pediatric population, offering access to a wide range of anterior cranial base, sellar, suprasellar, and frontal pathologies. The observed complication profile was consistent with the complexity and heterogeneity of the treated pathologies in this study. Prospective comparative studies are warranted to further define the role of this approach in pediatric neurosurgery.

PMID:
42295418
Bibliographic data and abstract were imported from PubMed on 15 Jun 2026.

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