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Transorbital Neuroendoscopic Surgery

Moe, Kris S. MD; Bergeron, Chris M. MD; Ellenbogen, Richard G. MD

doi: 10.1227/01.NEU.0000373431.08464.43
SURGICAL TECHNIQUE: EDITOR'S CHOICE: CRANIAL BASE: Surgical Technique

BACKGROUND: Transorbital neuroendoscopic surgery (TONES) pathways attempt to address some of the technical challenges of accessing laterally placed anterior skull base lesions or paramedian lesions that cross neurovascular structures. TONES approaches allow simultaneous coplanar visualization and working space above and below the skull base.

OBJECTIVE: To present an anatomic study, a description of the surgical techniques, and an analysis of the safety and efficacy of 20 consecutive procedures using TONES for a variety of pathological conditions.

METHODS: Sixteen patients underwent 20 TONES procedures for anterior skull base pathology, including repair of cerebrospinal leak, optic nerve decompression, repair of cranial base fractures, and removal of 3 skull base tumors. Ten patients were male, and 6 were female. The mean age at presentation was 44 years. Follow-up was 6 to 18 months with a mean of 9 months.

RESULTS: There were no significant complications or treatment failures in any of the 20 procedures. A variety of pathological conditions were treated, including cerebrospinal fluid leaks, fractures, mass lesions, and tumors. The TONES approach provided up to 4 separate access ports with ample exposure for manipulation and correction of the pathology.

CONCLUSION: This anatomic and prospective outcome study demonstrates that TONES provides safe and effective coplanar endoscopic access to the anterior and middle cranial base. These novel TONES approaches may be added to the wide range of published minimally invasive armamentarium when approaching challenging skull base pathology.

BACKGROUND: Transorbital neuroendoscopic surgery (TONES) accesses laterally placed anterior skull base or paramedian lesions that cross neurovascular structures. TONES approaches allow simultaneous coplanar visualization and working space above and below the skull base. OBJECTIVE: To present the anatomy surgical technique and the safety and efficacy of 20 consecutive procedures using TONES. METHODS: Sixteen patients underwent 20 TONES procedures for anterior skull base pathology, including repair of cerebrospinal leak, optic nerve decompression, repair of cranial base fractures, and removal of 3 skull base tumors. Ten patients were male, and 6 were female. The mean age at presentation was 44 years. Follow-up was 6 to 18 months with a mean of 9 months. RESULTS: There were no significant complications or treatment failures. The TONES approach provided up to 4 separate access ports with ample exposure for manipulation and correction of the pathology. CONCLUSION: This study demonstrates that TONES provides a safe and effective coplanar endoscopic access to the anterior and middle cranial base.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington (Moe)

Division of Head and Neck Surgery, Department of Surgery, University of California, San Diego School of Medicine, San Diego, California (Bergeron)

Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington (Ellenbogen)

Reprint requests: Kris S. Moe, MD, University of Washington Medical Center, 1959 NE Pacific St, Box 356161, Seattle, WA 98195—6161., E-mail: krismoe@u.washington.edu

Received, May 16, 2009.

Accepted, March 5, 2010.

Copyright © by the Congress of Neurological Surgeons