Transorbital neuroendoscopic surgery for lateral skull base pathologies: Early institutional experience.
5 affiliations
- 1Department of Neurosurgery, National Neuroscience Institute, Singapore.
- 2Department of Neurosurgery, Singapore General Hospital, Singapore.
- 3Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.
- 4Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore.
- 5Department of Otorhinolaryngology, Singapore General Hospital, Singapore.
Abstract
Background
Minimally invasive endoscopic approaches to the skull base have expanded the range of surgical options for lesions traditionally resected through transcranial approaches. Transorbital Neuroendoscopic Surgery (TONES) offers a direct lateral corridor to the anterior and middle cranial fossae while minimizing brain retraction and damage. We report two cases utilizing TONES for two distinct lateral skull base pathologies.Case description
We highlight the clinical outcomes of the TONES approach for two patients. Case 1 involved a 37-year-old male who underwent resection of a lateral sphenoid wing meningioma. Case 2 involved a 38-year-old female who underwent repair of bilateral lateral recess meningoencephaloceles and chronic cerebrospinal fluid (CSF) leak using a staged hybrid approach combining TONES and endoscopic endonasal surgery. In Case 1, a superior eyelid crease incision with lateral orbital rim osteotomy provided a direct transorbital corridor to the lateral sphenoid wing, achieving a Simpson Grade II resection while preserving cranial nerve function and excellent cosmesis. There was no recurrence at 6 months. In Case 2, a hybrid strategy using a left-sided TONES approach with the right-sided endoscopic endonasal transpterygoid repair addressed bilateral skull base defects with no CSF leak at 1 year. Both patients experienced good postoperative recovery without neurological morbidity.Conclusion
TONES represents an appropriate minimally invasive approach for selected lateral skull base pathologies. Strategies integrating transorbital and endonasal corridors create better exposure and minimize excessive dissection and morbidity. With an experienced team of committed oculoplastic surgeons, otorhinolaryngologists, and neurosurgeons, patients with selected lateral skull base pathologies could benefit from this surgical option.
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BibTeX
@article{tay2026transorbital,
title = {{Transorbital neuroendoscopic surgery for lateral skull base pathologies: Early institutional experience.}},
author = {Ernest Zhi Yu Tay and Qingping Joseph Feng and Jia Xu Lim and Ramez Wadie Kirollos and Beng Ti Ang and David Zhiwei Law and Jian Li Tan and Kaijun Tay and Jensen Wei Jie Ang},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_1289_2026},
url = {https://europepmc.org/article/MED/42974536},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Transorbital neuroendoscopic surgery for lateral skull base pathologies: Early institutional experience.
AU - Ernest Zhi Yu Tay
AU - Qingping Joseph Feng
AU - Jia Xu Lim
AU - Ramez Wadie Kirollos
AU - Beng Ti Ang
AU - David Zhiwei Law
AU - Jian Li Tan
AU - Kaijun Tay
AU - Jensen Wei Jie Ang
PY - 2026
DA - 2026/10/30
JO - Surgical neurology international
DO - 10.25259/sni_1289_2026
UR - https://europepmc.org/article/MED/42974536
AB - Background Minimally invasive endoscopic approaches to the skull base have expanded the range of surgical options for lesions traditionally resected through transcranial approaches. Transorbital Neuroendoscopic Surgery (TONES) offers a direct lateral corridor to the anterior and middle cranial fossae while minimizing brain retraction and damage. We report two cases utilizing TONES for two distinct lateral skull base pathologies.Case description We highlight the clinical outcomes of the TONES approach for two patients. Case 1 involved a 37-year-old male who underwent resection of a lateral sphenoid wing meningioma. Case 2 involved a 38-year-old female who underwent repair of bilateral lateral recess meningoencephaloceles and chronic cerebrospinal fluid (CSF) leak using a staged hybrid approach combining TONES and endoscopic endonasal surgery. In Case 1, a superior eyelid crease incision with lateral orbital rim osteotomy provided a direct transorbital corridor to the lateral sphenoid wing, achieving a Simpson Grade II resection while preserving cranial nerve function and excellent cosmesis. There was no recurrence at 6 months. In Case 2, a hybrid strategy using a left-sided TONES approach with the right-sided endoscopic endonasal transpterygoid repair addressed bilateral skull base defects with no CSF leak at 1 year. Both patients experienced good postoperative recovery without neurological morbidity.Conclusion TONES represents an appropriate minimally invasive approach for selected lateral skull base pathologies. Strategies integrating transorbital and endonasal corridors create better exposure and minimize excessive dissection and morbidity. With an experienced team of committed oculoplastic surgeons, otorhinolaryngologists, and neurosurgeons, patients with selected lateral skull base pathologies could benefit from this surgical option.
SN - 2229-5097
SN - 2152-7806
ER -