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The transorbital approach is a minimally invasive procedure to remove tumors around the eye, as well as tumors and aneurysms in certain areas of the brain.
The surgery involves small incisions around the eye to access the tumor or aneurysm. The minimally invasive approach leads to fewer risks and complications, faster recovery, and well-hidden scars.
At UPMC, our experienced specialists in neurosurgery and oculoplastic and orbital surgery perform the transorbital approach together. This team approach is safe and effective, and leads to better outcomes.
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The transorbital approach is a minimally invasive surgery commonly used to remove tumors in the eye socket and surrounding areas. It also is used for tumors, lesions, and aneurysms located at the base of the skull and front, middle, or side of the brain.
Transorbital refers to surgeries that occur through the eye socket. Small incisions that are hidden in the many natural folds around the eye socket allow the surgeon to access the aneurysm, tumor, or lesion.
The goal of this treatment is to safely remove the tumor or clip the aneurysm without affecting neurological or ocular function.
The advantage of the transorbital approach is it allows for easy access to the brain, eye, and surrounding areas through a small incision. There is less brain exposure, which lowers the risk of complications to the brain and other structures. Because the surgery involves both a neurosurgeon and an eye surgeon, there is also less risk to brain and eye function.
People typically experience less scarring, a shorter hospital stay, and faster recovery with the transorbital approach.
For large and complex tumors, the transorbital approach may be combined with other surgical techniques, such as the endoscopic endonasal approach (EEA).
There are several different types of transorbital approaches depending on the location of your tumor, lesion, or aneurysm. Each involves a small incision around the eye socket.
The transorbital approach types are:
Conditions we treat include:
Aneurysms, tumors, and other lesions in the eye, brain, and surrounding areas can cause debilitating, potentially life-threatening symptoms. Surgical treatment is critical to preserving eye and brain function.
The transorbital approach allows surgeons to successfully treat your condition with minimal risk to your eye and brain function. There is less scar tissue, less exposure of your brain, and a lower risk of complications compared to traditional open procedures. People typically experience less pain, fewer side effects, shorter hospital stays, and faster recoveries.
The transorbital approach, like all surgeries, carries risks.
These risks include:
These complications are very rare. Your surgical team will work together throughout the procedure to minimize your risk.
Before undergoing surgery, you will get very detailed imaging, including a CT scan and an MRI. Because the transorbital approach involves the eyes, you will also undergo a detailed eye examination. This exam involves noninvasive, painless tests and will help to plan the surgery and prevent eye-related complications during and after the procedure.
You also may undergo neuropsychological testing. These tests will help the surgical team understand the impact of the tumor and potential impact of the surgery on important functions like cognition.
If you take blood thinners, you should stop taking them before the procedure. Talk to your surgical team about all medications you take to see if you should stop taking them before the procedure.
Your surgical team will give you specific instructions about your presurgery diet and when to arrive for the procedure.
You will not be able to drive after the procedure, so you must arrange transportation home from the hospital.
The length of the procedure depends on the size, location, and complexity of your tumor, aneurysm, or lesion. It can take anywhere from two to 10 hours.
Afterward, you can expect to stay in the hospital for one to three days.
A neurosurgeon and an oculoplastic surgeon will work together to perform the surgery. You will be placed under general anesthesia and will be on an IV.
You will be placed on your back with your head in a clamp to keep it still during the procedure.
The oculoplastic surgeon will make the first incision. The length of the incision depends on the specific type of transorbital approach. It can be as small as 1-1/2 inches for the lateral orbitotomy to as long as 3 inches for the eyebrow craniotomy. Your surgeon will control any bleeding and dissect through muscle to get to the bone.
The neurosurgeon will then work to treat the tumor or aneurysm. Depending on the specific procedure, a small amount of bone may be removed. For example, for the eyebrow craniotomy, a small piece of the skull bone — about the size of a silver dollar — is removed. This small opening allows the surgeon to access the brain and remove the tumor or clip the aneurysm. For the lateral orbitotomy, a smaller amount of bone is removed.
The neurosurgeon and oculoplastic surgeon will work side by side as they attempt to remove the tumor or clip the aneurysm.
During the procedure, the surgeons will use a technology called image guidance. This imaging allows them to see the tumor or aneurysm along with important nearby structures, helping to prevent complications. They also may use surgical instruments such as a microscope, endoscope, or exoscope for better visualization.
Once the tumor is removed or the aneurysm is clipped, the surgeons will repair any bone that was removed. They may use metal plates or fat grafting as filler to preserve the original shape of the skull and eye. Once finished, the oculoplastic surgeon will close the incision.
After surgery, you will be moved to a recovery area until you wake up from the anesthesia. You will then be transferred to a hospital room.
Most people stay in the hospital for one to three days after surgery.
After the procedure, you will have a follow-up CT taken. Before discharge, we will ensure your pain is well-managed and you can perform functions like walking, eating, and having bowel movements. We will also monitor your eye function.
Although the pain after the transorbital approach is generally less than after a traditional craniotomy, you may need pain medication after the procedure.
Along with potential pain medication, we will also give you full instructions on caring for yourself and returning to activity.
You likely will experience some eye swelling for a few days to weeks after the transorbital approach. You may also experience some temporary vision changes, such as double vision, or the eyelid my swell completely closed.
Because the transorbital approach involves your eyes and the possibility of temporary vision changes, you should not drive until your surgical team clears you.
You should not do any strenuous lifting or bending for at least the first four weeks after surgery. Your team will clear you when you are ready.
You will not be permitted to wear contact lenses or eye makeup for the first month after surgery. You also will not be allowed to undergo any eyebrow procedures for the first three months after surgery.
For the first six months after surgery, you should wear sunglasses or a hat while outside to protect your surgical scars from the sun.
You should be fully recovered within four to six weeks after a transorbital approach. You may be able to return to certain activities, such as work, before that time.
You should discuss your recovery timeline with your doctor to ensure you can return to activities without experiencing complications.
You will have a follow-up appointment one week after surgery to have your stitches removed and your function checked. You will have a follow-up MRI three months after surgery to check on the tumor.
After that, you can expect to have a follow-up appointment each year to ensure your long-term health.
Complications after the transorbital approach are rare.
But you should call your doctor if you experience any unusual symptoms, such as:
When performed at a high-volume center with experienced surgeons, you can expect good outcomes from the transorbital approach. The surgery allows for the removal of tumors and aneurysms with minimal risk of complications.
The transorbital approach is a highly specialized procedure, so seeking care at an experienced center is important.
The UPMC Center for Cranial Base Surgery was the first skull base center established in the U.S. We have pioneered many advanced neurosurgical techniques, including the transorbital approaches. Our surgeons have years of experience performing these procedures with excellent outcomes.
UPMC treats these cases with a multidisciplinary approach. Your surgery will include both a neurosurgeon and an oculoplastic surgery specialist. This team approach ensures we can safely treat your aneurysm or tumor while preserving eye and brain function.
By UPMC Editorial Staff. Last reviewed on 2025-01-30 by Paul Andrew Gardner, MD and S. Tonya Stefko, MD.
