Objective      To compare the exposure of cavernous sinus from transfrontal and transorbitozygomatic direction in combined approach by model establishment and simulation in virtual reality system.       Methods      Image data of CT and MRI scanning performed to cadaver heads were inputted into the Dextroscope virtual reality system to build a three-dimensional model of cavernous sinus. Simulations of transfrontal and transorbitozygomatic direction in combined approach for cavernous sinus were made by lining landmark points selected on the calvaria and skull base to form spatial frameworks. Then

the distance

area of surgical entry and volume of tissues in the frameworks were gauged and compared.       Results      Distance between craniotomy window and exposed region

volume of operative space and brain tissue  involved in operative space before reaching cavernous sinus

  were larger from transfrontal direction than from transorbitozygomatic direction. Triangular area of craniotomy window and exposed field

volume of cranial nerves exposed before reaching cavernous sinus

anterior clinoid process and cranial nerves exposed after entering cavernous sinus were larger from transorbitozygomatic direction than  from transfrontal direction. And from transorbitozygomatic direction were larger than those from transfrontal direction. Difference of above data reached statistical significance (P0.05). Anterior clinoid process

internal carotid artery and middle cerebral artery trunk before reaching cavernous sinus were not shown in operative space form transorbitozygomatic direction. Volume of intracavernous sinus artery after entering cavernous sinus from transfrontal direction and transorbitozygomatic direction had no statistically significance（P=0.770）.       Conclusion      In the combined approach

advantages exist in the exposing of lesion located medial to cavernous sinus from transfrontal direction

and the exposing of lesion located lateral to cavernous sinus is more effective from transorbitozygomatic direction.