Superior eyelid transorbital approaches: a modular classification system.

The aim of this paper is to introduce a modular system for classifying the extensions to the superior eyelid transorbital approach. This classification system categorizes these extensions into two distinct groups: standard and extended. The extensions to the approach are further divided into those that widen the proximal corridor, which permits increased maneuverability, and those that widen the distal corridor, which provides access to various deep anatomical compartments. These two extension categories work in tandem and are modular, so they can be combined in a variety of different ways depending on the desired target. The proximal extensions consist of either the lateral orbitotomy (LO) or the superolateral orbitotomy (SLO), while the deep extensions include anterior clinoidectomy, flattening of the anterior middle fossa floor, and anterior petrosectomy. This classification allows surgeons to tailor their approach based on anatomical modules that can serve as an effective tool for surgical planning, tailored to the clinical needs of each individual case.

Transorbital skull base surgery represents a complex and challenging subspecialty within neurosurgery, often requiring innovative approaches to safely access critical anatomical structures. Among the transorbital approaches, also known as transorbital neuroendoscopic surgery, the superior eyelid (or superolateral) transorbital approach stands out as the most versatile from a neurosurgical perspective, offering effective access to the ventral paramedian skull base.1–5 In this paper, in an effort to enhance the understanding and promote the clinical utilization of this approach, we introduce a novel, modular classification system for the superolateral transorbital approach that describes its various extensions, similar to other approaches in the literature.6–9 This framework is grounded in anatomical studies that further solidify the theoretical basis for the classification.10–14