Purpose of Review <p>Transorbital neuroendoscopic surgery (TONES) provides minimally invasive access to the orbit and skull base through four principal orbital corridors: superior, lateral, medial and inferior. This review summarizes the current evidence base for each corridor, outlining anatomical considerations, expanding clinical indications and principles of approach selection, including the role of multiportal strategies.</p> Recent Findings <p>The superior corridor is the most established, with well-documented indications for anterior cranial fossa and frontal skull base tumors, spheno-orbital meningiomas, cerebrospinal fluid (CSF) leak repair, sinogenic complications and orbital roof fractures. The lateral corridor has emerged as an important route to the middle cranial fossa, cavernous sinus and Meckel’s cave, with increasing evidence supporting its use in selected sphenoid wing meningiomas and trigeminal schwannomas. The medial corridor provides targeted access for optic nerve decompression, medial orbital apex pathology and anterior cranial fossa tumors. The inferior corridor, though least frequently utilized, has defined applications for orbital floor reconstruction and access to the pterygopalatine and infratemporal fossa. Multiportal approaches combining transorbital with endonasal or open corridors extend the surgical options for complex multicompartment lesions.</p> Summary <p>TONES is an evolving and increasingly adopted platform for minimally invasive skull base surgery. Corridor selection is primarily governed by lesion location, extent and characteristics, supported by a structured approach selection algorithm. Multidisciplinary collaboration and careful patient selection are essential to optimizing outcomes.</p>

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Transorbital Neuroendoscopic Surgery: Indications and Approach Selection

  • Luke M. O’Neil,
  • Matthew Zhang,
  • Jacob Ruzevick,
  • Aria Jafari

摘要

Purpose of Review

Transorbital neuroendoscopic surgery (TONES) provides minimally invasive access to the orbit and skull base through four principal orbital corridors: superior, lateral, medial and inferior. This review summarizes the current evidence base for each corridor, outlining anatomical considerations, expanding clinical indications and principles of approach selection, including the role of multiportal strategies.

Recent Findings

The superior corridor is the most established, with well-documented indications for anterior cranial fossa and frontal skull base tumors, spheno-orbital meningiomas, cerebrospinal fluid (CSF) leak repair, sinogenic complications and orbital roof fractures. The lateral corridor has emerged as an important route to the middle cranial fossa, cavernous sinus and Meckel’s cave, with increasing evidence supporting its use in selected sphenoid wing meningiomas and trigeminal schwannomas. The medial corridor provides targeted access for optic nerve decompression, medial orbital apex pathology and anterior cranial fossa tumors. The inferior corridor, though least frequently utilized, has defined applications for orbital floor reconstruction and access to the pterygopalatine and infratemporal fossa. Multiportal approaches combining transorbital with endonasal or open corridors extend the surgical options for complex multicompartment lesions.

Summary

TONES is an evolving and increasingly adopted platform for minimally invasive skull base surgery. Corridor selection is primarily governed by lesion location, extent and characteristics, supported by a structured approach selection algorithm. Multidisciplinary collaboration and careful patient selection are essential to optimizing outcomes.