Transorbital endoscopic approach for repair of a lateral sphenoid sinus cerebrospinal fluid leak

The transorbital craniotomy represents a minimally invasive approach to the mesial structures of the middle fossa. This video depicts the approach to the lateral sphenoid recess in a patient with CSF rhinorrhea secondary to a lateral sphenoid encephalocele. The transorbital approach represents a unique advantage to repairing the lateral sphenoid sinus in comparison to the endoscopic endonasal approach, which requires traversing, and often transecting, the vidian nerve. Following identification of the skull base defect, repair is performed as an underlay with an abdominal fat graft. Following surgery, the patient had no recurrent rhinorrhea. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24207.