Navigating the delicate balance of the transorbital approach

The transorbital approach (TOA) is a significant advance in minimally invasive neurosurgery, eliminating the need for the extensive craniotomy and brain retraction typically associated with traditional methods. By accessing deep-brain and skull base lesions through a small periorbital incision, TOA significantly reduces surgical trauma, accelerates recovery, and offers superior esthetics. The well-equipped instruments and navigation system provide a magnified, meticulous view, proving effective for complex lesions near the orbital-cranial junction. However, the technique is challenged by the "narrow passage" and cannot be applied to all skull base lesions. Lateral orbitotomy, often performed via an upper eyelid crease incision, is a common corridor that requires careful navigation and anatomic knowledge to facilitate surgical dissection and minimize complications. Postoperative complications are usually transient, including periorbital edema, diplopia, and ptosis. Although serious long-term sequelae are rare, careful manipulation of orbital tissue and pupillary monitoring are crucial to prevent permanent nerve injury or visual impairment. TOA is a safe and valuable technique, provided there is careful patient selection and a high level of surgical expertise.