Endoscopic Transorbital Approach to Skull Base Lesions: Implications, Limitations, and Future Perspectives

Background/Objectives: The endoscopic transorbital approach (ETOA) has emerged over little more than a decade as a minimally invasive corridor to the anterior and middle cranial fossae, reaching territory lateral to the optic nerve and internal carotid artery that is difficult to access endonasally. Its flagship indication is the spheno-orbital meningioma, where the corridor aligns with the pathology and functions best as a planned, often decompressive strategy rather than a route to radical resection. This narrative review synthesizes the current evidence and defines the approach’s role, limitations, and priorities. Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched for English-language anatomical studies, clinical series, systematic reviews, and meta-analyses on the transorbital approach published between January 2016 and August 2026. Results: The evidence remains dominated by small, retrospective, single-center series and a handful of recent meta-analyses. Reported short-term outcomes—favorable proptosis relief, acceptable visual and cranial-nerve results, low pooled complication rates, and short recovery—are encouraging but constrained by short follow-up, heterogeneous nomenclature, and outcome reporting that grades residual tumor globally rather than by anatomical compartment. Gross total resection rates are lower than after transcranial surgery, and oncological equivalence has not been established. Technical, reconstructive, ophthalmic, and anatomical factors define the corridor’s ceiling, and ETOA is best positioned against endonasal and transcranial alternatives as a complementary rather than competing tool. Conclusions: ETOA is an established corridor whose maturation depends on reconstructive refinement, a flatter learning curve, standardized terminology and outcome sets, and prospective comparative data—consolidation rather than anatomical expansion.