Orbital roof fractures: neurologic and neurosurgical considerations

A wide spectrum of orbital roof fractures is presented through four clinical cases. Neurologic examination is emphasized and reviewed in order to detect the orbital roof fractures that may involve intracranial damage. A combined neurosurgical and ophthalmologic approach is indicated in basilar skull fractures with involvement of the inner table. Without intracranial damage or evidence of a dural tear, a superior orbitotomy is indicated to reduce the fracture and release the incarcerated orbital contents to improve ocular motility.