Endoscopic transorbital approach
Cadaveric anatomical dissection studies
In a cadaveric anatomical dissection study Gagliano et al. 1) anatomically demonstrate and compare the surgical perspectives offered by the endoscopic endonasal approach (EEA) and the endoscopic transorbital approach (ETOA), and explore their combined potential to provide a circumferential (360°) view of the orbit and its neurovascular contents.
1. Sample Size Fallacy
The study uses only 5 cadavers, raising serious questions about the reproducibility and generalizability of the findings.
Small N ≠ Big Insight.
No statistical validation or anatomical variability analysis is presented, reducing this to a surgical demonstration, not a scientific study.
Terms like *“360° vision”*, *“optimal exposure”*, and *“essential baseline”* are marketing language, not objective findings. There is no quantification of exposure or comparison of outcomes between EEA/ETOA and traditional approaches.
“360°” is symbolic, not measured.
Demonstrating that two endoscopic routes can “communicate” does not imply that such corridors are safe, practical, or indicated in real patients.
The leap from anatomical potential to surgical application is unjustified.
The study is more of a neuroanatomical teaching tool than a rigorous contribution to surgical science. The authors offer no discussion on:
- Intraoperative navigation
- Reconstruction strategies
- Risk of orbital compartment syndrome
- Learning curve or instrumentation limits
🧠 Neurosurgical Relevance
While the endoscopic endonasal approach (EEA) and ETOA are of growing interest in skull base and orbital surgery, this paper does not move the field forward. It reaffirms already known anatomic exposures without addressing the real-world challenges of adopting these approaches.
📉 Bottom Line
A visually interesting but clinically shallow cadaveric report that fails to deliver on its promise of surgical innovation. Before quoting “360° vision” in orbital surgery, the field needs comparative outcome studies, technical feasibility in live surgery, and functional results.
❝ Dissection is not demonstration. Exposure is not execution. And anatomical access ≠ clinical value. ❞