Transorbital approach for resection of intracranial skull base lesions: Outcomes and complications

Introduction: The transorbital approach has emerged in recent years as a minimally invasive corridor for accessing intracranial skull base lesions. We reviewed our experience developing a multidisciplinary superior eyelid transorbital technique to further elucidate the indications, and clinical outcomes of this novel approach.Methods: Retrospective single-center chart review of patients undergoing microscopic transorbital resection of skull base lesions via a superior eyelid or suprabrow incision was completed. Comparisions between neurologic, opthamologic, and cosmetic outcomes of those undergoing surgery in the first two years of adopting the tech-nique versus the last two years were completed. R-studio and descriptive statistics were used for analysis.Results: Forty patients (33 % male) underwent transorbital surgery from 2017 to 2021. Postoperatively, 72 % experienced symptom stability or improvement. No patients demonstrated mild decline in visual acuity (>0.5 LogMAR "the logarithm of the minimum angle of resolution" decrease) on long-term follow-up and there was no significant change in overall visual acuity from pre-op to post-op in all patients. Early postoperative complica-tions included infection, seizure, and hematoma, with an overall complication rate of 7.5 %. In the most recent year, there have been no significant postoperative complications, or need for additional cosmetic procedures in 21 patients. There have been no cerebrospinal fluid leaks throughout all the years of practice.Conclusion: The superior eyelid transorbital approach provides an innovative minimally invasive corridor for a variety of middle fossa, anterior skull base, and sellar region pathologies. Multidisciplinary collaboration has allowed us to develop this technique over time, minimize complications, and allow for good cosmetic and clinical outcomes.