Anteromedial approach to the orbit

This study evaluated the surgical results of the anteromedial approach for treatment of orbital lesions in 16 patients. Pre- and postoperatively, all patients underwent a complete physical examination focusing on the head and neck area including a thorough ophthalmologic evaluation, computerized tomography, and magnetic resonance imaging. The surgical approach was limited to a medial orbitotomy in five patients; the remaining 11 patients underwent a medial orbitotomy combined with an external sphenoethmoidectomy. The tumor was removed completely without damaging the intraorbital neurovascular structures in all but one patient whose recurrent clival chordoma extended beyond the limits of an extracranial approach. Fibro-osseous lesions, cavernous hemangiomas, and dermoid cysts were the most common pathologies. The follow-up ranged from 18 to 48 months, and no patient has shown evidence of a recurrence. One patient with a clival chordoma received radiation therapy. The lateral nasal skin incision healed with acceptable cosmetic results. The anteromedial approach to the orbit provides a wider working space and direct exposure while protecting neurovascular structures.