Endoscopic Transorbital Approach to Skull Base Lesions: Implications, Limitations, and Future Perspectives
4 affiliations
- 1Department of Cell Biology and Physiology, Brigham Young University, Provo, UT 84602, USA
- 2School of Medicine, Western Michigan University, Kalamazoo, MI 49007, USA
- 3Department of Neurosurgery, University of Michigan, Michigan Medicine, Ann Arbor, MI 48109, USA
- 4Department of Neurosciences Critical Care Medicine, AdventHealth, Orlando, FL 32803, USA
Abstract
Background/Objectives: The endoscopic transorbital approach (ETOA) has emerged over little more than a decade as a minimally invasive corridor to the anterior and middle cranial fossae, reaching territory lateral to the optic nerve and internal carotid artery that is difficult to access endonasally. Its flagship indication is the spheno-orbital meningioma, where the corridor aligns with the pathology and functions best as a planned, often decompressive strategy rather than a route to radical resection. This narrative review synthesizes the current evidence and defines the approach’s role, limitations, and priorities. Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched for English-language anatomical studies, clinical series, systematic reviews, and meta-analyses on the transorbital approach published between January 2016 and August 2026. Results: The evidence remains dominated by small, retrospective, single-center series and a handful of recent meta-analyses. Reported short-term outcomes—favorable proptosis relief, acceptable visual and cranial-nerve results, low pooled complication rates, and short recovery—are encouraging but constrained by short follow-up, heterogeneous nomenclature, and outcome reporting that grades residual tumor globally rather than by anatomical compartment. Gross total resection rates are lower than after transcranial surgery, and oncological equivalence has not been established. Technical, reconstructive, ophthalmic, and anatomical factors define the corridor’s ceiling, and ETOA is best positioned against endonasal and transcranial alternatives as a complementary rather than competing tool. Conclusions: ETOA is an established corridor whose maturation depends on reconstructive refinement, a flatter learning curve, standardized terminology and outcome sets, and prospective comparative data—consolidation rather than anatomical expansion.
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BibTeX
@article{rawson2026endoscopic,
title = {{Endoscopic Transorbital Approach to Skull Base Lesions: Implications, Limitations, and Future Perspectives}},
author = {Clayton Rawson and Gillian Ofori-Ntiamoah and Michael Karsy and Mehrdad Pahlevani},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18213443},
url = {https://www.mdpi.com/2072-6694/18/21/3443},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Endoscopic Transorbital Approach to Skull Base Lesions: Implications, Limitations, and Future Perspectives
AU - Clayton Rawson
AU - Gillian Ofori-Ntiamoah
AU - Michael Karsy
AU - Mehrdad Pahlevani
PY - 2026
DA - 2026/10/24
JO - Cancers
DO - 10.3390/cancers18213443
UR - https://www.mdpi.com/2072-6694/18/21/3443
AB - Background/Objectives: The endoscopic transorbital approach (ETOA) has emerged over little more than a decade as a minimally invasive corridor to the anterior and middle cranial fossae, reaching territory lateral to the optic nerve and internal carotid artery that is difficult to access endonasally. Its flagship indication is the spheno-orbital meningioma, where the corridor aligns with the pathology and functions best as a planned, often decompressive strategy rather than a route to radical resection. This narrative review synthesizes the current evidence and defines the approach’s role, limitations, and priorities. Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched for English-language anatomical studies, clinical series, systematic reviews, and meta-analyses on the transorbital approach published between January 2016 and August 2026. Results: The evidence remains dominated by small, retrospective, single-center series and a handful of recent meta-analyses. Reported short-term outcomes—favorable proptosis relief, acceptable visual and cranial-nerve results, low pooled complication rates, and short recovery—are encouraging but constrained by short follow-up, heterogeneous nomenclature, and outcome reporting that grades residual tumor globally rather than by anatomical compartment. Gross total resection rates are lower than after transcranial surgery, and oncological equivalence has not been established. Technical, reconstructive, ophthalmic, and anatomical factors define the corridor’s ceiling, and ETOA is best positioned against endonasal and transcranial alternatives as a complementary rather than competing tool. Conclusions: ETOA is an established corridor whose maturation depends on reconstructive refinement, a flatter learning curve, standardized terminology and outcome sets, and prospective comparative data—consolidation rather than anatomical expansion.
SN - 2072-6694
ER -