外侧经眶入路（LTOA）是一种相对较新的适用于前中颅窝旁区域病变的最小入路颅底手术方法。作者确定了该入路的目标区域，并描述了一系列具有详细测量视觉结果的病例，包括眼球突出测量结果。作者对连续一系列的LTOA患者进行了回顾性分析。确定了七个目标区域: 1）眶，2）小蝶突和前方环突，3）中颅窝，4）海绵窦和Meckel洞的侧壁，5）颞下窝，6）岩尖，7）前颅窝。作者使用术前和术后的MR和CT影像数据进行体积分析，计算骨和肿瘤的切除量，并提供详细的眼科、神经学和外观结果。 在这个队列中的20名患者中，病变分布在第2区（n = 10），第4区（n = 6），第3区（n = 2），第1区（n = 1），第5区（n = 1）。病理类型为脑膜瘤（n = 10），神经鞘瘤（n = 2），转移瘤（n = 2），表皮样囊肿（n = 1），皮样囊肿（n = 1），脑脊髓脑膜膨出（n = 1），腺瘤（n = 1），胶质母细胞瘤（n = 1）和炎性病变（n = 1）。9名患者的手术目标是完全切除，全部达到完全切除。8名患者的手术目标是次全切除（包括5例蝶窦-眶脑膜瘤、1例巨大海绵窦/Meckel洞神经鞘瘤、1例海绵窦垂体腺瘤和1例海绵窦表皮样囊肿），其中有7例达到次全切除，1例达到完全切除。2名患者的目标是活检，1名患者的目标是修复脑膨出。18名患者的视力保持稳定或有所改善，2名患者的视力恶化。术后早期暂时性复视、下垂眼睑、眼睑肿胀和眼眶麻木是常见的。所有术前复视患者在最后随访时均有改善。术后7名患者中有8名患者的眼球突出症状得到改善（平均矫正率为64%）。没有临床意义碎片化的术后内眼突（> 2 mm）。最常见的术后投诉是眼眶麻木（40%）。有1例脑脊液漏。大多数患者对其眼部（84%至100%的患者提供积极满意的反馈）和外观（75%至100%）的结果感到满意。 LTOA是一种安全的最小入路手术方法，适用于多个位置的一系列前中颅底病变。早期随访显示出眼球突出的显著改善，并且几乎没有术后内眼突的风险。暂时性复视、眼睑下垂和眼眶麻木是常见的，但这些情况均有所改善。精选病例非常重要，以确保良好的手术结果。

The lateral transorbital approach (LTOA) is a relatively new minimal access skull base approach suited for addressing paramedian pathology of the anterior and middle fossa. The authors define target zones for this approach and describe a series of cases with detailed measurements of visual outcomes, including those obtained with exophthalmometry.The authors performed a retrospective analysis of a consecutive series of LTOA patients. Seven target zones were identified: 1) the orbit, 2) the lesser sphenoid wing and anterior clinoid, 3) the middle fossa, 4) the lateral wall of the cavernous sinus and Meckel's cave, 5) the infratemporal fossa, 6) the petrous apex, and 7) the anterior fossa. The authors used volumetric analyses of preoperative and postoperative MR and CT imaging data to calculate the volume of bone and tumor removed and to provide detailed ophthalmological, neurological, and cosmetic outcomes.Of the 20 patients in this cohort, pathology was in zone 2 (n = 10), zone 4 (n = 6), zone 3 (n = 2), zone 1 (n = 1), and zone 5 (n = 1). Pathology was meningioma (n = 10), schwannoma (n = 2), metastasis (n = 2), epidermoid (n = 1), dermoid (n = 1), encephalocele (n = 1), adenoma (n = 1), glioblastoma (n = 1), and inflammatory lesion (n = 1). The goal was gross-total resection (GTR) in 9 patients, all of whom achieved GTR. Subtotal resection (STR) was the goal in 8 patients (5 spheno-orbital meningiomas, 1 giant cavernous sinus/Meckel's cave schwannoma, 1 cavernous sinus prolactinoma, and 1 cavernous sinus dermoid), 7 of whom achieved STR and 1 of whom achieved GTR. The goal was biopsy in 2 patient and repair of encephalocele in 1. Visual acuity was stable or improved in 18 patients and worse in 2. Transient early postoperative diplopia, ptosis, eyelid swelling, and peri-orbital numbness were common. All 9 patients with preoperative diplopia improved at their last follow-up. Seven of 8 patients with preoperative exophthalmos improved after surgery (average correction of 64%). There were no cases of clinically significant (> 2 mm) postoperative enophthalmos. The most frequent postoperative complaint was peri-orbital numbness (40%). There was 1 CSF leak. Most patients were satisfied with their ocular (84%-100% of patients provided positive satisfaction-related responses) and cosmetic (75%-100%) outcomes.The LTOA is a safe minimal access approach to a variety of paramedian anterior skull base pathologies in several locations. Early follow-up revealed excellent resolution of exophthalmos with little risk of clinically significant enophthalmos. Transient diplopia, ptosis, and peri-orbital numbness were common but improved. Careful case selection is critical to ensure good outcome.