Transcranial approach to the orbit: microsurgical anatomy

Area of Science:

• Neurosurgery
• Ophthalmology
• Anatomy

Background:

• Microsurgical access to the optic nerve and orbital apex is crucial for treating complex orbital pathologies.
• Understanding the anatomical nuances of different surgical corridors is essential for optimizing outcomes.

Purpose of the Study:

• To anatomically define and evaluate three microsurgical intraorbital routes to the optic nerve and orbital apex.
• To delineate the exposure capabilities and limitations of medial, central, and lateral approaches through the orbital roof.

Main Methods:

• Anatomical dissection of cadaver specimens.
• Evaluation of three microsurgical approaches: medial, central, and lateral.
• Definition of structural retractions and exposure ranges for each approach and its variants.

Main Results:

• The medial approach provides broad access to the intraorbital optic nerve.
• The central approach offers the shortest route, with variants accessing the midportion or posterior two-thirds of the optic nerve.
• The lateral approach, particularly one variant, provides excellent access to the optic nerve near the superior orbital fissure, ideal for lesions involving the cavernous sinus and orbit.

Conclusions:

• Each of the three microsurgical routes (medial, central, lateral) offers unique advantages for accessing the optic nerve and orbital apex.
• The choice of approach should be tailored to the specific location and extent of the pathology.
• Detailed anatomical knowledge of these routes is vital for successful microsurgical treatment of orbital apex and optic nerve lesions.