Outcomes of endoscopic sinus surgery (ESS) on sino-orbital osteomas: ophthalmic manifestations and visual outcomes from a 12-year multicenter experience and literature review

Osteomas are the most common benign craniofacial bone tumors that may extend into the orbital cavity. While the majority of them remain asymptomatic, orbital involvement can lead to clinically significant ophthalmologic manifestations. Although endoscopic sinus surgery (ESS) has been increasingly utilized, data focusing specifically on ophthalmologic outcomes following ESS in sino-orbital osteomas are limited. This 12-year multicenter descriptive cohort evaluated 12 patients with symptomatic sino-orbital osteomas managed with ESS, including advanced approaches such as Draf techniques and orbital transposition when indicated. Demographics, clinical and radiological presentation, tumor characteristics, surgical outcomes and complications during follow-up were collected and reviewed. The cohort population (7 men, 5 women; mean age 29.75 years) predominantly presented with proptosis, followed by diplopia, blurred vision and eyelid swelling. They originated most frequently from the frontoethmoidal and frontal sinuses with mean tumor dimensions of 4.2*2.9*1.9 cm. Complete excision was ultimately achieved in all cases either through a single or planned staged ESS. More than 90% of patients experienced resolution or substantial improvement of visual symptoms. No recurrences, cerebrospinal fluid leaks, major postoperative orbital complications or cosmetic deformities were observed. Our findings favor the expanding role of endoscopic techniques as an effective and safe minimally invasive approach and offer substantial rates of visual symptom resolution with minimal morbidity in sino-orbital osteomas. Comprehensive ophthalmic evaluation is recommended as part of a multidisciplinary approach to enhance the outcome of suspected cases.