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Tips and tricks for maximising access to the middle cranial fossa using the superior lateral orbital portal

Published online by Cambridge University Press:  12 December 2022

T A Patel Open the ORCID record for T A Patel [Opens in a new window] ,
H Mustak  and
D E Lubbe
T A Patel*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
H Mustak
Affiliation:
Division of Ophthalmology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, and Gruute Schuur Hospital, Cape Town, South Africa
D E Lubbe
Affiliation:
Division of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, and Groote Schuur Hospital, Cape Town, South Africa
*
Corresponding author: Terral Patel; Email: patelt5@upmc.edu
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Abstract

Background

Transorbital endoscopic approaches are becoming increasingly popular for skull base pathologies; the superior lateral orbital portal is one such approach to the middle cranial fossa. This paper provides a technical description that maximises the surgical portal and minimises morbidity.

Technical description

A superior lid crease incision is made extending laterally and the orbital rim is exposed. A subperiosteal dissection of the lateral and superior orbit is performed, with elevation of periosteum off Whitnall's tubercle, ligation of the recurrent branch of the middle meningeal artery, and identification of the superior orbital fissure. The lacrimal keyhole is then drilled away. The middle cranial fossa is accessed by drilling posterior to the orbital rim to expose: the temporalis muscle anterior-laterally, the dura of the temporal lobe posterior-laterally, the anterior cranial fossa superiorly and the periorbita medially.

Conclusion

These surgical steps can maximise the surgical portal and minimise morbidity, with avoidance of injury to surrounding structures.

Keywords

Endoscopyskull basecranial fossaanteriororbit
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 12 , December 2023 , pp. 1401 - 1405
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr T Patel takes responsibility for the integrity of the content of the paper

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