Translateral Orbital Wall Approach to the Orbit and Cavernous Sinus

BACKGROUND: Surgical approaches to lesions in either the orbit or cavernous sinus have been well documented; however, approaching lesions involving both areas remains challenging. OBJECTIVE: To examine the microsurgical and endoscopic anatomy of the orbit and cavernous sinus as seen through the orbitozygomatic and translateral orbital wall approaches. METHODS: Seven orbits and cavernous sinuses of formalin-fixed adult cadaveric heads were dissected and examined with the aid of the surgical microscope and 0° endoscope. RESULTS: The orbitozygomatic approach exposes the superior and lateral surfaces of the orbit, optic canal, superior orbital fissure, and cavernous sinus and offers a range of visibility and enough space for manipulation in both the horizontal and vertical planes. The translateral orbital wall approach exposes the lateral surface of the orbit, optic canal, and superior orbital fissure and can be extended to the lateral wall of the cavernous sinus. However, the surgical corridor to the orbital apex and adjacent cavernous sinus is narrow and deep. Endoscopic assistance may increase the exposure, especially around the anterior clinoid process and as far back as V3. CONCLUSION: The translateral orbital wall approach with endoscopic assistance provides access to the orbit and cavernous sinus, making it a good alternative to the orbitozygomatic approach for biopsy of unresectable lesions and removal of selected small lesions limited to the lateral aspect of the orbit and cavernous sinus. ABBREVIATION: ICA, internal carotid artery