A systematic review of the surgical anatomy of the orbital apex

Engin, G. F. J. P. M. Adriaensen, F. W. A. Hoefnagels, P. Saeed

Research output: Contribution to JournalArticleAcademicpeer-review

2 Citations (Scopus)


Purpose: The orbital apex is the narrowest part of the orbit, housing the link between the intracranial cavity and orbit. Knowledge of orbital apex anatomy is crucial to selecting a surgical approach and reducing the risk of complications. Our purpose is to summarize current knowledge on surgical anatomy and attempt to reach a consensus on definition of the orbital apex. Methods: The online databases of Embase, the Cochrane library, Web of Science and PubMed (MEDLINE) were queried in a comprehensive bibliographic search on the (surgical) anatomy of the orbital apex and consisted of a combination of two subjects, using indexed terms and free text: “Orbital Apex” and “Orbital Anatomy.” Results: A total of 114 relevant papers were included in this review. Numerous anatomical variations are described in the literature. Variations of the optic canal include duplication (0.64%) and keyhole anomaly (2.65%). Variations in pneumatization of the anterior clinoid process were unilateral in almost 10%, bilateral in 9%, and normal in 72%. A rare variant of the superior orbital fissure (SOF) is Warwick’s foramen, which appears as if the lowest portion of the SOF was separated from the main fissure by a transverse bony bridge. Conclusion: The definition of the orbital apex varies in the literature, and further research would most likely identify additional variations. A universal definition reporting these variations and pathology and imaging findings is essential for determining the optimal surgical approach to the orbital apex.
Original languageEnglish
Pages (from-to)169-178
Number of pages10
JournalSurgical and radiologic anatomy
Issue number2
Early online date2020
Publication statusPublished - Feb 2021


  • Anatomy
  • Apex
  • Orbit
  • Surgery

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