The evolving role of the oculoplastic surgeon in skull base surgery

Classical orbital approaches in skull base surgery have involved large incisions with extensive bone removal resulting in prolonged recovery with associated morbidity and mortality. The purpose of this review is to explore recent advances in skull base surgery that are applicable to the orbital surgeon.

Transnasal endoscopic surgery provides access to the medial 180 degrees of the orbit. Access to the lateral 180 degrees may be obtained using transmaxillary and transcranial techniques. Transorbital approaches and multiport techniques further expand the reach of the skull base surgeon. These minimally invasive techniques are supplanting the classical pterional, frontotemporal, frontotemporal orbitozygomatic, frontal, and subfrontal approaches.

The role of the orbital surgeon in skull base surgery is changing. Transnasal and transcranial approaches to orbital disorders using minimally invasive techniques are becoming more common. In addition, transorbital access to the skull base, paranasal sinuses, and anterior and middle cranial fossa is offering new opportunities for the orbital surgeon.