• Inraorbital lesions
• Multiportal combined transorbital transnasal appro
• Skull base lesions
• Superior-eyelid

Background. Orbital approaches have always represented a challenge and are still demanding. No ideal approach exists and the choice depends on many features: site and size of the lesion, anatomic relationships, and suspected nature of the lesion. The present study would like to emphasize our philosophy in the management of orbital and periorbital lesions and describe our considerations on the actual role of the orbit in skull base procedures.
Materials and Methods. Anatomic dissection was performed on 6 specimens (12 sides) at the Dissection Laboratory of “Fer à Moulin”, Paris. Patients included in the clinical part of the study presented pure intraorbital lesions (IOLs) or skull base lesions invading the orbit or the orbital walls. They were managed through superior, inferior, swinging eyelid endoscopic-assisted approach, or multiportal combined transorbital transnasal approach in three Italian tertiary care centres.
Results. We presented our personal scheme and discussed the feasibility of different surgical routes based on tumor location. The case series included 30 patients presenting a single-side IOL. The aim of surgery was curative in 23 (76.7%) cases, diagnostic in 7 (23.3%). The case series included 17 skull base lesions: 14 spheno-orbital meningiomas, 1 fibrous dysplasia of the anterior skull base, 1 V2 malignant Schwannoma, 1 Langerhans cell histiocytosis, and 13 pure IOLs: 5 lacrimal gland and 3 vascular tumors, 2 pseudotumors, 1 lymphoma, 1 benign Schwannoma and 1 orbital-maxillary Aspergillus. We observed no major postoperative complications, while 9 patients developed minor postoperative complications such as transient diplopia or V1-V2 dysesthesia. Among SOMs, the average amount of the tumor volume removed was 85.3%.
Discussion. Our proposal seems applicable and preliminary results are promising, showing successful functional and cosmetic outcomes with reduced morbidity.