The orbit is located between the cranium and face. Therefore, orbital tumors can affect not just the central nervous system functions such as vision and olfaction, as well as the brain, but also cosmetic aspects such as facial expressions. The orbit is an anatomic borderline area, which may necessitate the involvement of multiple specialists.

  The orbit is a narrow area extending from the posterior surface of the eyeball to the cranium, and contains nerves, muscles, glands, and supporting tissues that control visual function. All of these tissues are tumorigenic. In addition to these tumors (primary orbital tumors), metastatic lesions from multiple organs and, characteristically, neoplastic lesions extending from adjacent tissues can also be considered orbital tumors.

  In addition to actual tumors, intraorbital neoplastic lesions can arise from systemic inflammatory and endocrine diseases, vascular lesions, hematologic diseases, and trauma.

  Therefore, evaluating orbital tumors requires an systemic and oncological assessments, making them a diverse and complex group of diseases.

  An essential factor in understanding this complex disease is a thorough understanding of the normal orbital anatomy. Consequently, neuroradiological imaging can be used to identify the tumor's origin. The practitioner must then identify possible changes in that tissue and identify the actual disease based on other findings.

  In clinical practice, surgeons must use surgical techniques for tissue diagnosis, as molecular biological analysis of tumors has become increasingly important. However, even in these cases, recognizing that orbital tumors can spread and exacerbate through biopsy or partial resection remains crucial.

  Minimally invasive surgical procedures for orbital tumors must also be minimally invasive from a cosmetic perspective. However, minimally invasive treatment is not compatible with curative treatment for neoplastic diseases ; therefore, these must be treated on a case-by-case basis.

  Numerous departments, such as ophthalmology, otorhinolaryngology, and plastic surgery, propose interventions from their own standpoints ; thus, no clear unified view for managing some diseases exists. This article presents the basic knowledge and surgical techniques that enable neurosurgeons to appropriately manage orbital tumors encountered in daily practice.

  Transsphenoidal surgery (TSS) is the first-choice treatment for the management of functioning pituitary adenomas (except for prolactinomas) and non-functioning macroadenomas with visual disturbances and/or hypopituitarism. TSS combined with microscopy and intraoperative fluoroscopy, was established by Hardy in the 1960's. Moroever, endoscopic TSS has subsequently been introduced in many institutes.

  Recent advancements in extended TSS approaches have greatly contributed to the management of complex pituitary adenomas. However, transcranial approaches including a simultaneous combined supra-infrasellar approach is still indicated for large/giant and multilobulated adenomas. In this study, we review the surgical treatment for pituitary adenomas from a global perspective.

   [Background] An endoscope can enter the surgical field from a small entrance and provide a wide panoramic view. Conversely, an exoscope has a viewpoint similar to that of a microscope without any confliction of tools, which occurs in endoscopic surgery. Endoscopic surgery is a head-up surgery and entails a free visual axis as well as an endoscope.

   [Objective] To assess a combined endoscopic and exoscopic approach for managing brain tumors by taking advantage of these scopes.

   [Methods] The surgeon and scopist who controls the scopes work together to proceed with the surgery with an appropriate field of view. Using this approach, we can switch viewpoints inside and outside the surgical field. The approach and tumor decompression are performed with an exoscope with the minimum necessary skin incision and craniotomy, and the residual tumors in the deep site or around the corner are removed by endoscopic observation. The scopist fine-tunes the position, zoom, and focus of the scope. The conflictions between the instrument and endoscope can be eliminated by fine-tuning the scope and devising the instrument.

   [Result] Owing to the freedom of the visual axis, there are few restrictions on the postures of the surgeon and the patient. By utilizing the characteristics of the endoscope and exoscope, neurosurgery can be performed while minimizing blind spots and surgical invasion.

   [Conclusion] A minimally invasive and safe approach can be achieved by taking advantage of an endoscope and exoscope.

  Parasellar meningioma is a general term for meningiomas originating from the vicinity of the sella turcica. Because of the critical structures in this area, the displacement of the surrounding structures must be considered. This study discusses anterior clinoid meningiomas that occur in the parasellar region of the eye.

  Anterior clinoid meningiomas are classified as caudal, craniolateral, or medial. The most common symptom is visual deterioration, followed by headache. The deterioration of visual function may be attributed to the extension of the tumor into the optic canal. Surgical resection is the first-choice treatment. A pterional approach is usually selected for removing the anterior clinoid process and early decompression of the optic nerve. Stereotactic radiosurgery or radiotherapy results in good tumor control rates. Boron neutron capture therapy for high-grade meningiomas, currently in the clinical trial phase, is expected to be implemented in the future.

  Recently, anemia has been identified as a risk factor for cerebral venous sinus thrombosis (CVST) in addition to a genetic predisposition or trauma. However, most reports have focused on a single risk factor, whereas the association between multiple risk factors for CVST remains unclear. Herein, we report the case of a patient with CVST due to subcortical hemorrhage with macrocytic anemia while taking oral contraceptives. We hypothesized that CVST developed because of multiple risk factors, leading to subcortical hemorrhage. In addition to anticoagulant therapy, these risk factors were managed, and the CVST improved. Multiple risk factors may be identified while treating CVST, and searching for and treating each is necessary.

  In Japan, the number of breast cancer patients is increasing, with the highest number of cancer-related deaths among women aged 30-69 years. Although early detection and diagnostic screening are emphasized, mammography, a breast cancer screening method, is difficult in patients with implanted devices. We encountered a case of breast cancer detected incidentally during an implantable pulse generator (IPG) replacement. A 60-year-old woman had undegone bilateral subthalamic nucleus deep brain stimulation (DBS) for advanced Parkinson's disease 3.5 years prior. Intraoperatively, an induration measuring approximately 1cm was felt at the IPG implantation site (pocket) in the right thoracic region. A biopsy was performed, submitted for pathological examination, and a new IPG was placed. Pathological examination revealed an invasive ductal carcinoma. Right mastectomy and sentinel lymph node biopsy were performed, and the IPG was removed and reinserted on the left side during the same surgery. According to breast cancer practice guidelines, the patient received adjuvant therapy, including molecular-targeted therapy and chemotherapy, and is currently undergoing follow-up. Patients with DBS who are predisposed to breast cancer may require individual screening using ultrasonography instead of mammography. In patients with implanted devices, including those with DBS along with a predisposition to breast cancer, appropriate screening methods after implantation should be considered, as well the possibility of breast cancer and the need for breast cancer screening.