Transorbital Endoscopic Approach to the Lateral Cavernous Sinus

Approaches to the lateral cavernous sinus have been extensively described, both in terms of open craniotomy and endoscopic transnasal approaches. However, transorbital endoscopic approaches to the intracranial compartment have not been described. Here, we employed computer and cadaver models to assess the lateral retrocanthal endoscopic approach to the lateral cavernous sinus. Using a computer model, we calculated trajectories and potentially accessible areas to the middle fossa while employing a minimal amount of orbital retraction. Our calculations revealed adequate access to the lateral cavernous sinus, Meckel’s cave, orbital apex, and middle fossa floor. We then tested this approach on three cadavers and found sufficient access to the aforementioned areas using less than 5 mm of orbital retraction. As such, our study validates not only the use of computer simulation to plan operative approaches but also the feasibility of the lateral retrocanthal approach to the lateral cavernous sinus.