Anatomical justification and types of transorbital endoscopic approaches (review)

Abstract

Transcranial and transnasal approaches are the most common techniques for treatment of diseases and injuries of the eye socket and the base of the skull. However, development of endoscopic technology, microsurgical devices and minimally invasive techniques promotes increased interest in transorbital endoscopic approaches which allow to perform manipulations in the eye socket and structures of the base of the skull, namely, the anterior and middle cranial fossa. There are 4 types of such approaches: pre-caruncular, superior transpalpebral, lateral retro-canthal and inferior preseptal. Currently, precise indications for transorbital approaches are not formulated, and there are no algorithms for approach selection. The article describes the results of using these approaches in treatment of diseases and injuries of the orbit and the base of the skull. In injuries and tumors of the orbit and the base of the skull, cerebrospinal liquid leakage, infectious diseases, endocrine ophthalmopathy, transorbital endoscopic techniques provide good functional and cosmetic results. Among the advantages of these approaches are larger orbitotomy area and preservation of nasal structures, absence of large neurovascular bundles in the way of the approach, small incision, minimal brain retraction, good visibility and illumination of the structures. Transorbital endoscopic approaches to the base of the skull aren’t associated with significant neurological or vascular complications, hemorrhage, hematomas, infections. Diplopy, ptosis, enophthalmia are also quite rare. In literature, there are no descriptions of cases of loss of vision or postoperative cerebrospinal liquid leakage.