Role of Computer-Assisted Surgery in the Management of Pediatric Orbital Tumors: Insights from a Leading Referral Center.
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BACKGROUND/OBJECTIVES: Pediatric orbital tumors are rare and complex, requiring multidisciplinary care at specialized centers. Contemporary treatment paradigms emphasize centralized care delivery through experienced multidisciplinary teams to optimize patient outcomes. Recent advances in surgical planning technologies and intraoperative navigation systems have substantially enhanced surgical safety through improvement in tumor resection and reconstruction and reduction in complications, including recurrence of the lesion. Computed-aided surgical technologies enable precise virtual planning, minimally invasive approaches and more precise reconstruction methods when necessary by mean of patient-specific cutting guides, premolded orbital plates or individual patient solutions (IPS) prosthesis. Three-dimensional biomodelling visualizes tumor architecture and aids localization while preserving neurovascular structures, and real-time neuronavigation improves safety and efficacy. METHODS: We conducted a retrospective analysis of 98 pediatric patients with orbital tumors treated between 2014 and 2025 at a tertiary center to evaluate the use of computed-assisted surgical technologies and the indications for treatment. Inclusion criteria comprised all cases where computer-assisted techniques were employed. Patients were classified into two groups: Group 1-intraconal or extensive periorbital lesions with eye-sparing intent treated via craniofacial approaches; Group 2-periorbital tumors with orbital wall involvement, to analyze the use of the different technologies. Data collected included tumor age, type, location, technology used, adjunctive treatments, and postoperative outcomes. RESULTS: Twelve patients underwent computer-assisted surgery. Technologies employed over the last six years included intraoperative navigation, 3D planning with/without tumor segmentation, orbital-wall reconstruction by mirroring, IPS or titanium mesh bending, and preoperative biomodelling. Patients were grouped by tumor location and treatment goals: Group 1-intraorbital lesions (primarily intraconal or 270-360° involvement), including one case of orbital encephalocele treated transcranially; Group 2-periorbital tumors with orbital-wall destruction, treated mainly via midfacial approaches. Intraoperative navigation was used in 10/12 cases (8/11 with tumor segmentation); in 3 cases with ill-defined margins, navigation localized residual tumor. Virtual surgery predominated in Group 2 (4 patients) and one in Group 1, combined with cutting guides for margins and Individual Prosthetic Solutions (IPS) prosthesis fitting (two patients: titanium and PEEK). In two cases, virtual plans were performed, STL models printed, and premolded titanium meshes used. No complications related to tumor persistence or orbital disturbance were observed. CONCLUSIONS: Advanced surgical technologies substantially enhance safety, efficiency, and outcomes in pediatric orbital tumors. Technology-assisted approaches represent a paradigm shift in this complex field. Additional studies are needed to establish evidence-based protocols for systematic integration of technology in pediatric orbital tumor management.