Background: This video illustrates a minimally invasive neuroendoscopic transorbital technique used for the removal of a right orbital cyst accompanied by frontal sinus reconstruction. The approach enables a direct and efficient corridor to orbital and anterior skull base lesions, reducing the need for brain retraction while ensuring both functional and aesthetic benefits. Case Description: A 38-year-old male patient presented with progressive exophthalmos, double vision, and elevated intraocular pressure caused by a right orbital cyst. Radiological evaluation reveals a thick-walled cystic formation with hyperintense signal intensity on T1- and T2-weighted images. IV contrast-enhanced magnetic resonance ımaging was performed. No contrast enhancement was observed in the lesion. The lesion measures 35 × 30 × 26 mm and appears to be connected to the frontal sinus. Preoperative images showed that the lesion destroyed the frontal sinus and was connected to it. Eyebrow incision was preferred for intraoperative assessment of the frontal sinus to facilitate resection of the lesion within the frontal sinus and surgical maneuvers and reconstruction within the frontal sinus. Through a transorbital endoscopic route, the surgical team performed orbital rim drilling, complete cyst excision, and frontal sinus reconstruction using autologous fat graft material. Orbital rim drilling was performed at the orbital entrance within the skin incision margins, with the bone resection amount not exceeding 5 mm. The purpose of orbital rim drilling is to widen the endoscopic field of view and facilitate the maneuverability of surgical instruments. This did not cause any cosmetic problems. A 0° rigid endoscope and standard endoscopic endonasal surgical instruments were used. The postoperative period was uneventful, and the patient experienced immediate correction of exophthalmos. The histopathological evaluation was reported as an epidermoid cyst with hemorrhage. At the 4-week follow-up, eye movements and intraocular pressure were normal, and diplopia had completely resolved. Conclusion: The transorbital endoscopic approach represents a safe, efficient, and cosmetically favorable option for treating orbital cystic lesions. It provides excellent visualization of the surgical field with minimal invasiveness, allowing for rapid recovery and optimal cosmetic outcomes. This experience underlines the versatility and clinical usefulness of this technique in properly selected cases.
Karımzada et al. (Fri,) studied this question.