The Transorbital Approach for Repair of Lateral Sphenoid Sinus Encephaloceles

Sphenoid sinus cerebrospinal fluid (CSF) leaks are usually associated with idiopathic intracranial hypertension and tend to occur in the lateral sphenoid sinus, frequently laterally to V2, an area of the skull base challenging to visualize without manipulation of other important structures. Endoscopic endonasal approaches have been the main route of repair for these leaks. The transorbital approach provides another alternative route for direct repair of lateral sphenoid sinus CSF leaks. Here, we discuss the pertinent surgical anatomy, describe the step-by-step repair of these leaks, and discuss the limitations and advantages of the transorbital approaches compared to the endoscopic endonasal approaches through a detailed discussion of surgical cases from our practice.