Surgical approaches to diseases of the orbital apex

The authors report their experience with transcranial approaches to the orbit in situations where adequate exposure would not have been obtained with the usual orbital techniques. In addition to the standard frontal craniotomy, a supraorbital transcranial approach is described that involves removal of the superior rim and roof of the orbit, allowing exposure of all but the floor of the orbit. The main indication for this technique is a mass deep in the orbital apex that would be difficult or impossible to expose with a conventional orbitotomy. Seven representative cases are presented that illustrate conditions falling in that category.