The orbit can harbour a variety of lesions and their approach and treatment should be dictated by anatomical location and pathology. The proximity of the orbit to the sinonasal cavity and anterior and middle cranial fossae make it an ideal location for collaboration among neurosurgeons, otolaryngologists, and ophthalmologists. Traditional orbitotomy, microsurgical transcranial, and endoscopic endonasal approaches (EEA) provide 360-degree access for biopsy or resection of both primary intraorbital lesions and those involving the structures surrounding the orbits. The most appropriate surgical corridor will avoid crossing the vertical plane of the optic nerve and will also avoid excess retraction of the globe. A multidisciplinary team with all available specialties is therefore ideal for management of orbital lesions. This chapter outlines the anatomy, clinical presentation, and techniques that guide surgeons in management of these lesions.