Chapter 2 - Combined Endonasal and Transorbital Approach

Summary

It is often necessary to use more than one skull base approach for the treatment of complex lesions to maximize resection and minimize morbidity and mortality. The advent of widespread endoscope use has increased the armamentarium for skull base surgeons to tackle these dangerous tumors and lesions. A combined endoscopic transnasal and simultaneous transorbital approach allows for minimally invasive multiportal surgery to reach difficult-to-access skull base regions with minimal collateral damage. Multiple surgical trajectories can be readily and safely obtained in a minimally invasive manner. The use of standard zero-degree endoscopes via this approach allows for easier and safer manipulation of the target lesion. In this way, multistage or more invasive surgery can often be avoided, minimizing complications, and lesions can be removed en-bloc.