Transorbital neuroendoscopic surgery for the treatment of skull base lesions.

TitleTransorbital neuroendoscopic surgery for the treatment of skull base lesions.
Publication TypeJournal Article
Year of Publication2016
AuthorsRamakrishna R, Kim LJ, Bly RA, Moe K, Ferreira M
JournalJ Clin Neurosci
Date Published2016 Feb
KeywordsAdolescent, Adult, Aged, Aged, 80 and over, Child, Craniotomy, Female, Humans, Male, Middle Aged, Neuroendoscopy, Orbit, Postoperative Complications, Retrospective Studies, Skull Base, Young Adult

Transorbital neuroendoscopic surgery (TONES) is a relatively new technique that not only allows access to the contents of the orbit but also the intracranial compartment, including the anterior cranial fossa, middle fossa and lateral cavernous sinus. In this study, we aimed to retrospectively review the largest experience to our knowledge with regards to surgical outcomes of skull base pathologies treated with a TONES procedure. Forty patients (aged 3-89 years) underwent 45 TONES procedures between the years of 2006-2013. Pathologies were cerebrospinal fluid leak repair (n=16), traumatic fracture (n=8), tumor (n=11), meningoencephalocele (n=5), hematoma (n=1), and infection (n=4). Three patients had a persistent complication at 3 months, including a case each of enophthalmos (unnoticed by patient), epiphora (delayed presentation at 2 months requiring dacryocystorhinostomy), and ptosis (improved at 1 year). Surgical success was achieved in all patients. Of special import, there were no cases of visual decline, diplopia, or stroke. There was no mortality. To our knowledge this is the first study and largest experience of TONES (level 4 evidence) to detail outcomes with respect to skull base pathologies. Our results indicate that TONES procedures can be performed with minimal morbidity. Further studies are needed to assess equivalency with craniotomy based approaches though this initial report is encouraging.

Alternate JournalJ Clin Neurosci
PubMed ID26563603
PubMed Central IDPMC5955706
Grant ListR21 EB016122 / EB / NIBIB NIH HHS / United States
T32 DC000018 / DC / NIDCD NIH HHS / United States