Lateral Transorbital Approach for Lateral Sphenoid Defects: Anatomy, Surgery, Nasoseptal Flap Use, and a 4-Case...

Area of Science:

• Otorhinolaryngology
• Neurosurgery
• Skull Base Surgery

Background:

• Complex skull base repairs, particularly in the lateral recess of pneumatized sphenoid sinuses, present surgical challenges.
• Standard transnasal methods may lead to nasal morbidity and hypesthesia.

Purpose of the Study:

• To evaluate the effectiveness and anatomical benefits of the lateral transorbital approach for complex skull base repairs.
• To compare this approach with traditional transnasal techniques.

Main Methods:

• A case series involving four patients from two institutions was conducted.
• Three patients with spontaneous cerebrospinal fluid (CSF) leaks underwent lateral transorbital repair; one with skull base fractures received a combined transnasal and transorbital repair using a nasoseptal flap.

Main Results:

• The lateral transorbital approach provided effective access to the lateral sphenoid recess using standard instruments.
• This method avoided nasal morbidity and hypesthesia associated with transpterygoid access.
• Nasoseptal flaps, when needed, were placed under direct vision via the transorbital route for complex defects.

Conclusions:

• The lateral transorbital approach improves visualization and reduces nerve injury risk for pneumatized sphenoid sinus defect repair.
• It offers a valuable alternative with lower nasal morbidity.
• The nasoseptal flap is effective for cerebrospinal fluid (CSF) leak prevention in transorbital procedures.