The Lateral Transorbital Approach for Removal of Select Sphenoid Wing and Middle Fossa Meningiomas

The lateral transorbital approach (LTOA) is a relatively new approach to the skull base that has only recently been applied in vivo in the management of complex skull base pathology. LTOA utilizes natural planes superolateral to the orbit as a corridor to access the cavernous sinus, Meckel’s cave, middle cranial fossa, and portions of the anterior fossa, posterior fossa, infratemporal fossa, and the parapharyngeal space. Meningiomas are the most common benign intracranial tumor. Unless small and asymptomatic, surgery remains the first-line therapy for most meningiomas that require treatment. Meningiomas are classified based on their dural attachments, which are not equally distributed along the meninges. The transorbital approach (TOA) is a novel minimally invasive alternative to open craniotomy suitable for removal of select spheno-orbital, sphenoid wing, and middle fossa meningiomas. Since other chapters in this book focus on spheno-orbital meningiomas, this chapter will describe the TOA specifically for sphenoid wing and middle fossa meningiomas.