Transpalpebral Lateral Orbital Approach to Anterior and Middle Cranial Fossa: An Anatomical Study with Clinical Applications

Background: A variety of minimally invasive approaches can be used to access the anterior and middle skull base region, each with distinct advantages and limitations. The transpalpebral lateral orbital approach provides adequate working space to access lesions located in the anterior and middle cranial fossa.

Objectives: To describe the step-by-step technique to perform a transpalpebral lateral orbital approach to the anterior and middle fossae using cadaver dissections and provide case examples for clinical correlation.

Methods: Formalin-fixed and colored-injected specimens were prepared for dissection. The specimen was dissected under microscopic and endoscopic magnification. The transpalpebral lateral orbitofrontal approach was performed and documented in stepwise photographic images. Two cavernous sinus tumors were selected to illustrate the surgical nuances of the technique.

Results: The transpalpebral lateral orbital approach provides excellent access to lesions located in the anterior cranial fossa, parasellar region, interpeduncular cistern and middle cranial fossa. The use of an endoscope can increase the surgical maneuverability while enhancing visualization and control of neurovascular structures, in particular for the middle cranial fossa. After performing the keyhole burr hole, the periorbita is carefully separated from the orbital roof. A lateral orbital craniotomy flap is created, that can include the frontal bone, frontal process of the zygomatic bone, part of the orbital roof, or the supraorbital rim. This approach was successfully performed in 2 patients, the first a 72-year-old female with a hyperostotic sphenoid wing meningioma and the second a 82-year-old female with pachymeningeal disease of the cavernous sinus. The surgical goals of tumor resection, obtaining a pathological diagnosis, and symptom relief were feasible through a minimal access approach to a complex skull base region.

Conclusion: The transpalpebral lateral orbital approach is an effective surgical alternative for carefully selected lesions located in the anterior and middle cranial fossa. Cosmetic and visual outcomes are excellent.

Publication History

Article published online:
01 February 2023