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J Neurol Surg B Skull Base
DOI: 10.1055/a-2724-4360
Original Article

ENDOSCOPIC TRANSORBITAL APPROACH TO MIDDLE CRANIAL FOSSA AND KAWASE’S TRIANGLE– FEASIBILITY, DESCRIPTIVE AND QUANTITATIVE ANATOMICAL STUDY

Authors

  • SARTHAK MEHTA

    1   NEUROSURGERY, National Institute of Mental Health and Neurosciences, Bengaluru, India (Ringgold ID: RIN29148)

  • Dwarakanath Srinivas

    2   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, India (Ringgold ID: RIN29148)

  • Gyani Jail Singh Birua

    3   Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India (Ringgold ID: RIN29148)

  • Harsh Deora 

    1   NEUROSURGERY, National Institute of Mental Health and Neurosciences, Bengaluru, India (Ringgold ID: RIN29148)

  • Anita Mahadevan

    4   Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India (Ringgold ID: RIN29148)
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BACKGROUND: Skull base surgeries have increasingly adopted minimally invasive endoscopic transnasal approaches; however, limitations such as restricted accessibility to lesions located lateral to the optic nerve and internal carotid artery have led to exploring alternative routes like the orbit for accessing the middle cranial fossae. This study investigates transorbital endoscopic approaches in cadavers, focusing on the middle cranial fossa's anatomy and evaluating the potential and challenges of exposing the middle skull base and petrous apex. OBJECTIVE: To assess the surgical anatomy and feasibility of anterior petrosectomy via a transorbital endoscopic approach, provide essential morphometric data, and evaluate associated morbidity through a systematic literature review. METHODS: Ten sides of five cryopreserved cadavers were dissected using a 0-degree Karl Storz Endoscope through a lateral retrocanthal incision. Step-by-step photographs of anterior petrosectomy through the endoscopic transorbital route and evaluation of access to middle fossa triangles is performed. A systematic PubMed review analyzed 47 studies (In vivo and anatomical dissections) regarding the transorbital approach's indications, techniques, and complications. RESULTS: In cadavers with a 50 cm head circumference, the median distances from the conjunctival incision to the SOF and IOF lateral borders were 1.8 cm and 1.9 cm, respectively. The median length of the petrous bone drilled was 2.0 cm. Additional measurements of intracranial landmarks were recorded. CONCLUSION: The study confirmed the feasibility of using a transorbital endoscope to explore the middle cranial fossa base through a lateral retrocanthal incision, offering improved visualization. However, caution is necessary due to the proximity of intra-orbital structures.



Publication History

Received: 11 August 2025

Accepted after revision: 13 October 2025

Accepted Manuscript online:
17 October 2025

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