Transcaruncular, Transorbital Approach for Repair of Challenging Frontal Sinus Encephalocele

Introduction: Frontal sinus meningoceles and encephaloceles encompass a rare spectrum of pathologies that pose a significant surgical challenge. To manage them, traditional open approaches such as osteoplastic flaps and frontal sinus cranialization through trephination have given way to less invasive, incisionless endoscopic techniques. As surgeons become increasingly facile operating in this area, advancements in instrumentation continue to further support this paradigm shift in management. Despite this, the variable pattern of pneumatization and anatomy of the frontal sinus makes instrumenting and reconstructing all of its various zones in a purely endoscopic manner challenging, nonetheless. To overcome this, surgeons augment endoscopic techniques with minor external incisions that provide critical access to challenging treatment zones of the frontal sinus. Recent anatomical feasibility studies have proposed the transcaruncular approach as a powerful working corridor that provides access through the medial orbit to the frontal sinus with excellent postoperative cosmesis.