The Sagittal Crest and Mid-subtemporal Ridge

The superior eyelid endoscopic transorbital approach (SETOA) has been shown to be particularly suitable for obtaining minimally invasive access to the lateral portion of the middle cranial fossa. Anatomical investigations and clinical applications of SETOA underlined two key anatomical landmarks, both visible during the drilling of the greater sphenoid wing. 1) The “sagittal crest,” a bony ridge with a sagittal orientation that constantly remains unnoticed after lateral-to-medial drilling of the GSW, is located between the medial temporal dura and the posterior periorbita, superior to the foramen rotundum. 2) The “mid-subtemporal ridge,” a bony prominence located on the floor of the middle cranial fossa, lateral to the foramen rotundum. In this chapter we illustrate the anatomical relationship of this structure and the need of their removal during transorbital surgery.