{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T21:47:45Z","timestamp":1787694465451,"version":"build-2784847793"},"reference-count":34,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>During the last few years, the superior eyelid endoscopic transorbital approach has been proposed as a new minimally invasive pathway to access skull base lesions, mostly in ophthalmologic, otolaryngologic, and maxillofacial surgeries. However, most neurosurgeons performing minimally invasive endoscopic neurosurgery do not usually employ the orbit as a surgical corridor. The authors undertook this technical and anatomical study to contribute a neurosurgical perspective, exploring the different possibilities of this novel route. Ten dissections were performed on ten formalin-fixed specimens to further refine the transorbital technique. As part of the study, the authors also report an illustrative transorbital surgery case to further detail key surgical landmarks. Herein, we would like to discuss equipment, key anatomical landmarks, and surgical skills and stress the steps and details to ensure a safe and successful procedure. We believe it could be critical to promote and encourage the neurosurgical community to overcome difficulties and ensure a successful surgery by following these key recommendations.<\/jats:p>","DOI":"10.3390\/jcm12206484","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T12:46:13Z","timestamp":1697114773000},"page":"6484","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["The Transorbital Approach, A Game-Changer in Neurosurgery: A Guide to Safe and Reliable Surgery Based on Anatomical Principles"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4008-9092","authenticated-orcid":false,"given":"Matteo","family":"de Notaris","sequence":"first","affiliation":[{"name":"Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, 84125 Salerno, Italy"},{"name":"Department of Neuroscience, Neurosurgery Operative Unit, \u201cSan Pio\u201d Hospital, 82100 Benevento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Sacco","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1023-958X","authenticated-orcid":false,"given":"Francesco","family":"Corrivetti","sequence":"additional","affiliation":[{"name":"Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, 84125 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1416-0817","authenticated-orcid":false,"given":"Michele","family":"Grasso","sequence":"additional","affiliation":[{"name":"Department of Surgery, Otorhinolaryngology Operative Unit, \u201cSan Pio\u201d Hospital, 82100 Benevento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4918-6857","authenticated-orcid":false,"given":"Sergio","family":"Corvino","sequence":"additional","affiliation":[{"name":"Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, 84125 Salerno, Italy"},{"name":"Department of Neurological Sciences, Division of Neurosurgery, Universit\u00e0 degli Studi di Napoli Federico II, 80055 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5360-5810","authenticated-orcid":false,"given":"Amedeo","family":"Piazza","sequence":"additional","affiliation":[{"name":"Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, 84125 Salerno, Italy"},{"name":"Department of Neurosurgery, Sapienza University, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doo-Sik","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06531, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Iaconetta","sequence":"additional","affiliation":[{"name":"Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d\u2019Aragona, University of Salerno, 84084 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"ons16","DOI":"10.1227\/01.NEU.0000373431.08464.43","article-title":"Transorbital Neuroendoscopic Surgery","volume":"67","author":"Moe","year":"2010","journal-title":"Oper. Neurosurg."},{"key":"ref_2","first-page":"11","article-title":"Lateral Transorbital Neuroendoscopic Approach to the Lateral Cavernous Sinus","volume":"75","author":"Bly","year":"2014","journal-title":"J. Neurol. Surg. B Skull Base"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"988131","DOI":"10.3389\/fonc.2022.988131","article-title":"Endoscopic Transorbital Avenue to the Skull Base: Four-Step Conceptual Analysis of the Anatomic Journey","volume":"12","author":"Guizzardi","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Serioli, S., Nizzola, M., Plou, P., De Bonis, A., Meyer, J., Leonel, L.C.P.C., Tooley, A.A., Wagner, L.H., Bradley, E.A., and Van Gompel, J.J. (2023). Surgical Anatomy of the Microscopic and Endoscopic Transorbital Approach to the Middle Fossa and Cavernous Sinus: Anatomo-Radiological Study with Clinical Applications. Cancers, 15.","DOI":"10.3390\/cancers15184435"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1055\/s-0040-1713101","article-title":"Endoscopic Transorbital Approaches to Anterior and Middle Cranial Fossa: A Laboratory Investigation on Surgical Anatomy and Potential Routes","volume":"82","author":"Nannavecchia","year":"2021","journal-title":"J. Neurol. Surg. B Skull Base"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e172","DOI":"10.1227\/ons.0000000000000527","article-title":"The \u201cCrista Ovale\u201d: A Reliable Anatomical Landmark in Transorbital Endoscopic Approaches to the Middle Cranial Fossa","volume":"24","author":"Noiphithak","year":"2023","journal-title":"Oper. Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e206","DOI":"10.1227\/ons.0000000000000131","article-title":"\u201cSagittal Crest\u201d: Definition, Stepwise Dissection, and Clinical Implications From a Transorbital Perspective","volume":"22","author":"Corrivetti","year":"2022","journal-title":"Oper. Neurosurg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"622","DOI":"10.3171\/2016.8.JNS16465","article-title":"Endoscopic Transorbital Route to the Cavernous Sinus through the Meningo-Orbital Band: A Descriptive Anatomical Study","volume":"127","author":"Dallan","year":"2017","journal-title":"J. Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Houlihan, L.M., Loymak, T., Abramov, I., Jubran, J.H., Staudinger Knoll, A.J., Howshar, J.T., O\u2019Sullivan, M.G.J., Lawton, M.T., and Preul, M.C. (2023). The Biportal Transorbital Approach: Quantitative Comparison of the Anterior Subfrontal Craniotomy, Bilateral Transorbital Endoscopic, and Microscopic Approaches. J. Neurosurg., 1\u201310.","DOI":"10.3171\/2023.4.JNS221866"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e267","DOI":"10.1227\/ons.0000000000000308","article-title":"Endoscopic Transorbital Approach to the Middle Fossa: Qualitative and Quantitative Anatomic Study","volume":"23","author":"Guizzardi","year":"2022","journal-title":"Oper. Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E494","DOI":"10.1093\/ons\/opab310","article-title":"Quantitative Anatomic Comparison of Microsurgical Transcranial, Endoscopic Endonasal, and Transorbital Approaches to the Spheno-Orbital Region","volume":"21","author":"Agosti","year":"2021","journal-title":"Oper. Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"966051","DOI":"10.3389\/fonc.2022.966051","article-title":"Development of 3-Dimensional Printed Simulation Surgical Training Models for Endoscopic Endonasal and Transorbital Surgery","volume":"12","author":"Lee","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.wneu.2020.01.115","article-title":"Comparative Analysis of Endoscopic Transorbital Approach and Extended Mini-Pterional Approach for Sphenoid Wing Meningiomas with Osseous Involvement: Preliminary Surgical Results","volume":"139","author":"Park","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1007\/s00701-020-04694-y","article-title":"Clinical Applications of the Endoscopic Transorbital Approach for Various Lesions","volume":"163","author":"Yoo","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.3171\/2017.3.JNS163110","article-title":"Transorbital Endoscopic Eyelid Approach for Resection of Sphenoorbital Meningiomas with Predominant Hyperostosis: Report of 2 Cases","volume":"128","author":"Almeida","year":"2018","journal-title":"J. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e201","DOI":"10.1227\/ons.0000000000000496","article-title":"Transorbital Endoscopic Approach for Middle Fossa Floor\/Lateral Cavernous Sinus Meningioma: 2-Dimensional Operative Video","volume":"24","author":"Carnevale","year":"2023","journal-title":"Oper. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1055\/s-0040-1718914","article-title":"The Role of the Transorbital Superior Eyelid Approach in the Management of Selected Spheno-Orbital Meningiomas: In-Depth Analysis of Indications, Technique, and Outcomes from the Study of a Cohort of 35 Patients","volume":"83","author":"Locatelli","year":"2022","journal-title":"J. Neurol. Surg. B Skull Base"},{"key":"ref_18","first-page":"514","article-title":"Transorbital Endoscopic Approaches to the Skull Base: Current Concepts and Future Perspectives","volume":"60","author":"Locatelli","year":"2016","journal-title":"J. Neurosurg. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/978-3-319-39546-3_19","article-title":"Spheno-Orbital Meningiomas: When the Endoscopic Approach Is Better","volume":"124","author":"Peron","year":"2017","journal-title":"Acta Neurochir. Suppl."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Agosti, E., Zeppieri, M., De Maria, L., Mangili, M., Rapisarda, A., Ius, T., Spadea, L., Salati, C., Tel, A., and Pontoriero, A. (2023). Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes. J. Clin. Med., 12.","DOI":"10.3390\/jcm12185840"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Carnevale, J.A., Pandey, A., Ramirez-Loera, C., Goldberg, J.L., Bander, E.D., Henderson, F., Niogi, S.N., Tabaee, A., Kacker, A., and Anand, V.K. (2023). Endonasal, Supraorbital, and Transorbital Approaches: Minimal Access Endoscope-Assisted Surgical Approaches for Meningiomas in the Anterior and Middle Cranial Fossae. J. Neurosurg., 1\u20139.","DOI":"10.3171\/2023.5.JNS23103"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.wneu.2015.02.034","article-title":"Multiportal Combined Transorbital Transnasal Endoscopic Approach for the Management of Selected Skull Base Lesions: Preliminary Experience","volume":"84","author":"Dallan","year":"2015","journal-title":"World Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e342","DOI":"10.1227\/ons.0000000000000577","article-title":"Multiportal Combined Endoscopic Endonasal and Transorbital Pathways: Qualitative and Quantitative Anatomic Studies of the \u201cConnection\u201d Skull Base Areas","volume":"24","author":"Guizzardi","year":"2023","journal-title":"Oper. Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.wneu.2010.03.033","article-title":"Multiportal Endoscopic Approaches to the Central Skull Base: A Cadaveric Study","volume":"73","author":"Ciporen","year":"2010","journal-title":"World Neurosurg."},{"key":"ref_25","first-page":"1821","article-title":"The Feasibility of Three Port Endonasal, Transorbital, and Sublabial Approach to the Petroclival Region: Neurosurgical Audit and Multiportal Anatomic Quantitative Investigation","volume":"165","author":"Corvino","year":"2023","journal-title":"Acta Neurochir."},{"key":"ref_26","first-page":"406","article-title":"Combined Endoscopic Endonasal and Transorbital Approach to Skull Base Tumors: A Systematic Literature Review","volume":"66","author":"Guizzardi","year":"2022","journal-title":"J. Neurosurg. Sci."},{"key":"ref_27","first-page":"179","article-title":"Refinement of the Extradural Anterior Clinoidectomy: Surgical Anatomy of the Orbitotemporal Periosteal Fold","volume":"61","author":"Froelich","year":"2007","journal-title":"Neurosurgery"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1097\/SCS.0000000000009096","article-title":"Alternative Path for Optic Nerve Decompression in Pseudotumor Cerebri With Full Endoscopic Lateral Transorbital Approach","volume":"34","author":"Ozdogan","year":"2023","journal-title":"J. Craniofac Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.3171\/2019.7.JNS191743","article-title":"Endoscopic Transorbital Approach to the Infratemporal Fossa and Parapharyngeal Space: A Cadaveric Study","volume":"133","author":"Gerges","year":"2019","journal-title":"J. Neurosurg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.wneu.2019.07.152","article-title":"Lateral Transorbital Neuroendoscopic Approach for Intraconal Meningioma of the Orbital Apex: Technical Nuances and Literature Review","volume":"131","author":"Luzzi","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"247","DOI":"10.4193\/Rhino15.237","article-title":"Transorbital Endoscopic Assisted Management of Intraorbital Lesions: Lessons Learned from Our First 9 Cases","volume":"54","author":"Dallan","year":"2016","journal-title":"Rhinology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s10143-023-01980-y","article-title":"Endoscopic Transorbital Approach for Skull Base Lesions: A Report of 16 Clinical Cases","volume":"46","author":"Han","year":"2023","journal-title":"Neurosurg. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1227\/ons.0000000000000725","article-title":"Lateral Transorbital Approach for Repair of Lateral Sphenoid Sinus Meningoencephaloceles in Proximity to Foramen Rotundum: Cadaveric Study and Case Report","volume":"25","author":"Mathios","year":"2023","journal-title":"Oper. Neurosurg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1055\/s-0040-1713854","article-title":"Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-Term Outcomes and Surgical Technique","volume":"81","author":"Goncalves","year":"2020","journal-title":"J. Neurol. Surg. B Skull Base"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6484\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:05:37Z","timestamp":1760130337000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6484"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,12]]},"references-count":34,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jcm12206484"],"URL":"https:\/\/doi.org\/10.3390\/jcm12206484","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,12]]}}}