Orbital resection by intranasal technique (ORBIT): A new classification system for reporting endoscopically resectable primary benign orbital tumors

Jafari A 1 , Adappa ND 2 , Anagnos VJ 2 , Campbell RG 3 , Castelnuovo P 4 , Chalian A 2 Show all authors , Chambers CB 5 , Chitguppi C 6 , Dallan I 7 , El Rassi E 8 , Freitag SK 9 , Fernandez Miranda JC 10 , Ferreira M 11 , Gardner PA 12 , Gudis DA 13 , Harvey RJ 3 , Huang Q 14 , Humphreys IM 1 , Kennedy DW 2 , Lee JYK 15 , Lehmann AE 16 , Locatelli D 17 , McKinney KA 8 , Moreau A 18 , Nyquist G 5 , Palmer JN 2 , Prepageran N 19 , Pribitkin EA 5 , Rabinowitz MR 5 , Rosen MR 5 , Sacks R 3 , Sharma D 1 , Snyderman CH 20 , Tonya Stefko S 20 , Stokken JK 21 , Wang EW 20 , Workman AD 22 , Wu AW 23 , Yu JY 20 , Zhang MM 5 , Zhou B 14 , Bleier BS 22

Affiliations 

  • 1 Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
  • 2 Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  • 3 Faculty of Medicine and Health Science, Macquarie University, Sydney, New South Wales, Australia
  • 4 Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
  • 5 Department of Ophthalmology, University of Washington, Seattle, Washington, USA
  • 6 Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
  • 7 Ear, Nose, Throat (ENT) Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
  • 8 Department of Otolaryngology-Head & Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  • 9 Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
  • 10 Department of Neurosurgery, Stanford University, Palo Alto, California, USA
  • 11 Department of Neurosurgery, University of Washington, Seattle, Washington, USA
  • 12 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  • 13 Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
  • 14 Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head & Neck Surgery, Ministry of Education, Beijing, China
  • 15 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  • 16 Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
  • 17 Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale Di Circolo E Fondazione Macchi, University of Insubria, Varese, Italy
  • 18 Department of Ophthalmology, University of Oklahoma, Oklahoma City, Oklahoma, USA
  • 19 Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Jalan Universiti, Wilayah Persekutuan, Kuala Lumpur, Malaysia
  • 20 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  • 21 Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
  • 22 Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
  • 23 Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, USA
Int Forum Allergy Rhinol, 2023 Oct;13(10):1852-1863.
PMID: 36808854 DOI: 10.1002/alr.23141

Abstract

BACKGROUND: The Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) staging system has become the gold standard for outcomes reporting in endoscopic orbital surgery for orbital cavernous hemangiomas (OCHs). A recent systematic review demonstrated similar outcomes between OCHs and other primary benign orbital tumors (PBOTs). Therefore, we hypothesized that a simplified and more comprehensive classification system could be developed to predict surgical outcomes of other PBOTs.

METHODS: Patient and tumor characteristics as well as surgical outcomes from 11 international centers were recorded. All tumors were retrospectively assigned an Orbital Resection by Intranasal Technique (ORBIT) class and stratified based on surgical approach as either exclusively endoscopic or combined (endoscopic and open). Outcomes based on approach were compared using chi-squared or Fisher's exact tests. The Cochrane-Armitage test for trend was used to analyze outcomes by class.

RESULTS: Findings from 110 PBOTs from 110 patients (age 49.0 ± 15.0 years, 51.9% female) were included in the analysis. Higher ORBIT class was associated with a lower likelihood of gross total resection (GTR). GTR was more likely to be achieved when an exclusively endoscopic approach was utilized (p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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