The Orbital and Oculoplastic Surgery Perspective

The safety and efficacy of transorbital neurological surgery for select intracranial and skull base pathology is augmented by multidisciplinary collaboration. Orbital surgeons, also called oculoplastic or oculofacial surgeons, are fellowship-trained ophthalmologists subspecialized in surgery of the delicate and anatomically complex soft tissues surrounding the eyes, including the eyelids, orbital contents, globes, and bony orbit. Transorbital approaches to the anterior and middle crania fossae are a natural evolution and extension of minimally invasive orbital decompression surgery performed commonly by oculoplastic and orbital surgeons for other utilities. The orbital surgeon’s skill set augments the neurosurgical and skull-base surgery team approach through detailed preoperative ophthalmologic analysis of the visual system including appropriate patient selection and risk stratification, intraoperative experience with orbital anatomy and tissue handling, and postoperative monitoring of the visual system and orbit to appropriately identify and treat complications and facilitate comprehensive, critical evaluation of surgical outcomes. As these techniques proliferate and evolve, critical evaluation of postoperative outcomes and interdisciplinary dialogue will enable optimal case selection for transorbital approaches.