Abstract
Introduction Common approaches to remove skull base tumors invading the orbital apex, cavernous
sinus, middle fossa, or temporal lobe include orbitozygomatic or fronto-orbital craniotomies.
Recently, different types of orbital approaches have been described as alternative
minimally invasive techniques.
Objective With this systematic review, we analyzed the typology of intracranial tumors treated
through transorbital approaches, especially through the lateral orbital (LO) wall,
and analyzing the complication rates and outcomes.
Design A PubMed/Medline search was performed using the criteria: “orbitotomy,” “transorbital,”
“transpalpebral,” and “lateral orbitotomy” in combination with “cavernous sinus,”
“middle fossa,” and “temporal lobe.”
Main Outcome Measures From these reports, we collected diagnoses, lesion sizes and locations, approaches,
outcomes, aesthetic outcomes, postoperative ptosis, postoperative cranial nerve (CN)
palsies, length of CN deficits postoperatively, overall complications, and follow-up
length.
Results A total of 13 papers and 3 of our own cases matched our inclusion criteria totaling
160 patients. Most patients were treated for meningiomas (135, 84.4%). The approaches
included the LO approach (n = 54; 33.8%), deep transorbital (n = 5; 3.1%), mini-LO (n = 91; 56.9%), and modified LO (n = 10; 6.2%). While not all cases reported excision success, the various LO approaches
achieved total (n = 42; 26.25%) resection margins. Postoperative ocular complications (including CN
palsies, proptosis, or ocular disturbances) totaled 46 (28.8%) new CN palsies, 23
(14.4%) occurrences of vision loss, 1 (1.7%) with worsened proptosis, 5 (3.9%) with
worsened enophthalmos, and 42 (26.3%) other complications.
Conclusion Microsurgical LO approaches, especially in the era of radiosurgery, may become a
suitable alternative to other more established craniotomies.
Keywords
lateral orbitotomy - cavernous sinus - middle fossa - temporal lobe
