Transcranial orbital approaches: comparison of the surgical access and the importance of the zygomatic arch removal.

Orbital surgery may be encountered in neurosurgical practice because of the proximity of lesions to cranial structures and potential transcranial extension. Orbital surgery is divided into microsurgical and endoscopic approaches. Microsurgical techniques can be classified as transorbital or transcranial. To perform these surgical approaches, a thorough understanding of orbital anatomy is essential. Six cadaveric orbits from three silicone-injected adult heads were used in this study. Following a pterional craniotomy and orbitotomy, central, medial, and lateral transcranial approaches were performed to all specimens. Additionally, a modification to the lateral route was introduced. In this study, we discuss transcranial orbital approaches, identifying suitable approaches for specific lesion locations and highlighting their advantages through cadaveric dissections. Moreover, we demonstrate that the accessible surgical space can be expanded by incorporating a modification to the lateral transcranial approach. In orbital surgery, the appropriate surgical technique should be selected based on the lesion's location. Mastery of orbital anatomy is a prerequisite for these procedures, and the surgical exposure can be enhanced using the modifications described in our study.