title: Transorbital neuroendoscopic surgery for the treatment of skull base lesions.
abstract: 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.
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Rohan
authors.initials: R
authors.lastname: Ramakrishna
authors.affiliation: Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Randall A
authors.initials: RA
authors.lastname: Bly
authors.affiliation: Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA; Department of Otolaryngology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Kris
authors.initials: K
authors.lastname: Moe
authors.affiliation: Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: manuelf3@u.washington.edu.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ferreira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D009915:Orbit / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D055815:Young Adult
keywords: CSF leak; Endoscope; Neuroendoscopy; Neurosurgery; Pituitary; Skull base; Transorbital