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Abstract
Twenty years ago, if you had told the neurosurgery community that in a mere 2 decades, skull base surgeons would be working through the nostrils using endoscopes to remove not only the majority of pituitary tumors but also craniopharyngiomas, chordomas, chondrosarcomas, and tuberculum sella meningiomas, your remarks would have been met with raised eyebrows and a few polite chuckles of disbelief. From our current perspective, it is now difficult to imagine not removing these tumors using an extended endoscopic endonasal approach (EEA). The EEA provides a unique perspective to an area of the brain that is difficult to expose without manipulating, and possibly damaging, the very anatomy we are trying so desperately to preserve. Whether outcomes have improved compared with more traditional transcranial approaches is still a matter of debate, but one would certainly not be faulted for choosing an EEA, which has now become a widely accepted neurosurgical technique.
To some of us in the skull base community, it has become more and more apparent that transorbital approaches are poised to explode into our collective neurosurgical consciousness as a similarly powerful minimal access approach that can expose specific areas of the skull base that have vexed neurosurgeons for decades.The idea of using the orbit, already crowded with our most precious sensory organ, as a route for surgery, seems counterintuitive and even in direct conflict to our primary maxim, “primum non nocere.” The purpose of this article is to compare and contrast the 2 approaches, review the similarities and differences, and help provide a greater understanding of how the transorbital approach may soon transform our neurosurgical perspective.
