7 Orbital Approach
Lesions behind the equator of the globe are best approached through a lateral orbit (modified Krönlein) approach or a transcranial approach. The lateral orbit approach provides adequate exposure for most lesions lateral to the optic nerve. Lateral lesions originating in the orbit apex can be difficult to remove using this approach. Lesions of the optic nerve, orbital apex, or medial orbit are best exposed through a transcranial approach. The contents within the orbit can be approached between the superior oblique and levator palpebrae muscles, between the levator and superior rectus muscles, or between the superior rectus and lateral rectus muscles depending on the location of the pathology. The transcranial approach can be extended into the subdural compartment for lesions such as optic gliomas.
7.1 Transcranial Orbital Approach
Key Steps
Key Steps
Position: Supine, head lateral
Step 1. Semilunar skin incision (Fig. 7.1)
Step 2. Scalp elevation in one layer with release of the supraorbital nerve (Fig. 7.2)
Step 3. Frontal craniotomy (Fig. 7.4)
Step 4. Removal of the supraorbital bar (Fig. 7.8)
Step 5. Opening of the periorbita (Fig. 7.11)
Step 6. Dissection in the orbital cavity through the roof of the orbit (Fig. 7.13)
Illustrated Steps with Commentary




























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