TRANSORBITAL SURGERY

Transorbital neuroendoscopic surgery (TONES) is a minimally invasive surgical technique used to access and treat various brain and skull base pathologies through the nose and ethmoid sinus. It involves inserting an endoscope through the orbit (eye socket) to access the brain, providing a less invasive alternative to traditional open cranial surgery.

The TONES procedure begins with a small incision near the inner corner of the eye and the insertion of an endoscope into the orbit. This allows the surgeon to visualize and access the skull base, optic nerves, and other structures in the region. The endoscope provides a high-definition, magnified view of the surgical area, allowing for precise navigation and manipulation of instruments.

The primary advantage of TONES is its minimally invasive nature, which results in reduced trauma to surrounding tissues, faster recovery times, and fewer surgical complications compared to open cranial surgery. It can be used to treat a range of conditions, including dermoid and epidermoid tumors, pituitary tumors, meningiomas, orbital lesions, and cerebrospinal fluid (CSF) leaks.

For dermoid and epidermoid tumors, TONES allows for the complete removal of these lesions while preserving normal brain tissue. Pituitary tumors, such as adenomas, can be accessed and resected through the transorbital approach, avoiding the need for traditional transsphenoidal surgery through the nose. This approach also allows for optic nerve decompression in cases where the tumor is compressing the nerve.

In addition to tumor removal, TONES can be utilized for the repair of CSF leaks, which occur when there is a breach in the lining that surrounds the brain and spinal cord. Through the transorbital route, surgeons can access the site of the leak and repair it using graft materials or sealing techniques.

While TONES offers numerous benefits, it is not suitable for all patients or all pathologies. Factors such as the size and location of the lesion, patient anatomy, and surgeon expertise play a role in determining whether a patient is a candidate for TONES. It is essential to consult with a neurosurgeon experienced in this technique to determine the most appropriate treatment plan for each individual case.

In summary, transorbital neuroendoscopic surgery (TONES) is a minimally invasive surgical approach that allows access to the brain and skull base through the orbit. It offers numerous advantages, including reduced trauma, faster recovery, and fewer complications compared to open cranial surgery. TONES can be used to treat various pathologies, including tumors, orbital lesions, and CSF leaks, providing an alternative option for patients who may benefit from a less invasive surgical approach.

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This is a case of a cavernous sinus meningioma tumour operated on by Professor Profyris through a keyhole tranorbital neuroendoscopic approach (TONES).  The green arrows on the left hand images demonstrate the cavernnous sinus meningioma tumour which has been removed, as can be seen by the images on the right.  After meticulous study of the pre-operative imaging a transorbital neuroendoscopic approach was elected in order to avoid any injury to the brains temporal lobe, which was “in the way.” Recovery was uneventful.  The video below shows the endoscopic intra-operative footage from removal of this tumour.

This is a case of a cavernous sinus epidermoid operated on by Professor Profyris through a keyhole tranorbital neuroendoscopic approach (TONES).  The green arrows on the left hand images demonstrate the cavernnous sinus epidermoid which has been removed, as can be seen by the images on the right.  After meticulous study of the pre-operative imaging a transorbital neuroendoscopic approach was elected in order to avoid any injury to the brains temporal lobe, which was “in the way.”

This is a case of sphenoid wing meningioma causing pressure on they eyeball.  The eyeball was protruding and vision was being compromised.  This case was operated upon by Professor Profyris through a keyhole transorbital Neuroendoscopic (TONES) Approach.  The green arrows on the left hand images demonstrate the tumour causing significant orbital wall thickening and compression which has been removed, as can be seen by the images on the right.