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Related Experiment Video

Updated: Apr 17, 2026

Three-Dimensional Reconstruction of Orbital Fractures

Three-Dimensional Reconstruction of Orbital Fractures

Published on: May 16, 2025

"Round-the-Clock" Surgical Access to the Orbit.

Alessandro Paluzzi¹, Paul A Gardner¹, Juan C Fernandez-Miranda¹

¹Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.

Journal of Neurological Surgery. Part B, Skull Base

|February 17, 2015

Summary

This study presents a surgical algorithm using a clock model to determine optimal approaches for orbital pathology, ensuring safe access around the optic nerve.

Keywords:

endonasal endoscopic approach orbit orbital tumors

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Published on: August 11, 2015

Area of Science:

Neurosurgery
Ophthalmology
Surgical Anatomy

Background:

Orbital pathologies require precise surgical access.
Choosing the correct surgical approach is critical for patient outcomes.
Existing methods may lack a systematic approach for diverse orbital lesions.

Purpose of the Study:

To develop and describe a novel algorithm for selecting the optimal surgical approach to orbital pathology.
To provide surgeons with a structured method for planning orbital surgeries.
To enhance understanding of surgical access planes relative to orbital structures.

Main Methods:

Review of 12 neurosurgical cases involving orbital pathology.
Application of a "clock model" centered on the optic nerve using coronal MRI/CT scans.
Analysis of surgical approaches including external, endoscopic, and combined techniques.

Main Results:

The clock model effectively maps surgical access: medial transconjunctival (1-6), endoscopic endonasal (1-7), lateral micro-orbitotomy (8-10), frontotemporal craniotomy (9-1).
Combined approaches offer 360-degree access to the orbit.
Surgical planning prioritizes avoiding the optic nerve's plane.

Conclusions:

The described algorithm and clock model provide a comprehensive framework for orbital surgery.
Optimal surgical approach selection is guided by the principle of avoiding the optic nerve.
This systematic approach facilitates safe and effective management of orbital pathologies.