Endoscopic versus open resection of pediatric periorbital masses using a novel subcutaneous operative channel: a focus on safety and aesthetic outcomes.

Background: The periorbital region is one of the most prominent areas for social interaction. Conventional open surgeries in this area often leave scars or cause aesthetic and functional issues owing to tissue tension. Endoscopic methods are increasingly being applied to unconventional surgical approaches in pediatric surgery. This study aimed to introduce a method of resecting pediatric periorbital masses using endoscopic assistance with hidden incisions within the hairline and to compare its outcomes with those of conventional open surgeries. Methods: Clinical data were collected from 46 pediatric patients diagnosed with "periorbital masses" who underwent mass resection surgery in the Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, between August 31, 2023, and September 1, 2024. The data collected included sex, age, surgery and hospitalization duration, mass size, postoperative pathology results, and total hospitalization costs. Postoperative follow-up data included the presence of complications, recurrence, and adoption of anti-scar treatment measures. Statistical analysis and visualization were performed using SPSS 22.0 and GraphPad Prism 10, with statistical significance set at P<0.05. Results: A total of 46 children diagnosed with periorbital masses were included in the study, consisting of 30 males and 16 females, aged 0-14 years (median age: 3 years). The median age of patients undergoing conventional open surgery was 4 years (1-6 years), while the median age of those receiving endoscopic-assisted surgery was 1 year (1-3 years), with the latter being significantly younger. No statistically significant differences were found between the two surgical approaches in terms of mass size, hospitalization duration, average hospitalization costs, nor postoperative complication rates. However, the average surgical duration was significantly longer with the new technique. No recurrence was observed in any patient during the follow-up period. Notably, none of the 17 patients who underwent the new surgical technique required postoperative anti-scar treatment, compared to the higher rate of anti-scar treatment in the conventional surgery group. Conclusions: Endoscopic resection of pediatric periorbital masses using a novel subcutaneous operative channel is a minimally invasive, safe, effective, cost-effective, and yields superior cosmetic outcomes, presenting a promising clinical application.