Transorbital Endoscopic Approach to the Orbital Apex Via the Superior Lid Crease: A Clinical Series

A retrospective case series was performed to describe a transorbital endoscopic approach to the superior orbital apex. The surgical technique involved an extended lid crease incision and subperiosteal dissection along the orbital roof. Three patients were identified for inclusion (a 9-year-old male, a 21-year-old male, and a 55-year-old female). Follow-up time ranged from 10 months to 2 years. Procedural indications included biopsy or debulking of orbital and/or dural tissue for antineutrophilic cytoplasmic antibody vasculitis with hypertrophic pachymeningitis, orbital myxoma, and Langerhans cell histiocytosis. No intraoperative complications were encountered. All patients developed postoperative ptosis and upgaze limitation, which persisted in 1 patient at 12-month follow-up. There were no instances of a permanent sensory deficit or cerebrospinal fluid leak. The transorbital approach to the superior apex under endoscopic guidance represents a reasonable alternative to a lateral orbitotomy or craniotomy for the biopsy of orbital masses.