World Neurosurg. 2021 Apr 30:S1878-8750(21)00647-1. doi: 10.1016/j.wneu.2021.04.104. Online ahead of print.
ABSTRACT
BACKGROUND: Transorbital neuroendoscopic surgery (TONES) offers a new level of minimally invasive, minimally disfiguring skull base surgery with maximal surgical visualization.
METHODS: This review systematically assesses the body of published anatomical (cadaveric) and clinical evidence for the approach. PubMed, Cochrane Library, Ovid MEDLINE, and EMBASE were systematically searched for publications where the TONES surgical technique was used in an anatomical, clinical, or combined study. The outcomes of interest included identification of the pathologies, operative outcomes, and complication rates.
RESULTS: Twenty-three papers were selected for this systematic review: 10 were purely anatomical, 10 were clinical, and 3 had both clinical and cadaveric components. The papers reported 69 patients undergoing transorbit al or combined transorbital and transnasal intervention. A total of 30 cases of cerebrospinal fluid leak were documented; of these, 28 (93%) had successful resolution, 2 (7%) had recurrence, and 5 (15%) experienced complications. A total of 31 tumors were biopsied (n=1), resected (n=22), or debulked (n=8). Meningiomas were the most common lesion managed via TONES, with 5 of 7 patients with meningioma who reported preoperative neurological deficits experiencing an improvement in extraocular movement impairment, visual acuity, proptosis, and ptosis. Transient postoperative clinical sequelae, including diplopia and ptosis, were increasingly associated with the superior lid crease incision and the sole transorbital approach.
CONCLUSIONS: TONES is a significant development in transorbital skull base surgery. However, comprehensive, robust, comparative analyses and increasing use and generalizability of this technique in skull base surgery are awaited.
PMID:33940270 | DOI:10.1016/j.wneu.2021.04.104
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