Comparative Analysis of Cranio-Orbito-Zygomatic and Transorbital Routes to the Superior Orbital Fissure, Orbital Apex, Clinoidal Space, and Suprasellar Cisterns

The superior orbital fissure (SOF), orbital apex (OA), clinoidal space (ClnS) and suprasellar parachiasmatic cisterns (SSPC) represent frequent surgical targets in skull base neurosurgery. Surgical access to these regions remains challenging due to the high density of critical neurovascular structures within multiple cisternal compartments. This study aimed to evaluate a transorbital surgical route to the SOF, OA, ClnS, and SSPC and compare the limits of exposure with those of the conventional trans-sylvian route through a cranio-orbitozygomatic approach (COZA).

Methods

Cadaveric dissections were performed to expose the orbital apex, cavernous sinus, sphenoid wing, and suprasellar parachiasmatic cisterns. Trans-sylvian route via COZA was carried out initially, and this was subsequently followed by a transorbital approach directed at the same anatomical areas. Surgical corridors were systematically analyzed, and exposure boundaries were documented and compared.