Transorbital surgery, or transorbital neuroendoscopic surgery (TONES), is a less invasive surgical approach that involves the insertion of an endoscope and other tiny surgical instruments through an incision near the eye. This enables surgeons to work on structures in the brain and skull base.

Transorbital surgery is a minimally invasive surgical alternative to open cranial surgery. The less invasive nature of the surgery allows for quicker recovery times, less scarring and reduced trauma as opposed to open surgery.

Why do you perform transorbital surgery?

Transorbital surgery may be considered for the following conditions:

  1. Orbital lesions: Surgery to remove orbital tumours is a meticulous process that involves the safe surgical resection of the tumour. Surgery is advised when the tumour places pressure on the optic nerve and affects eyesight, causes the eye to protrude (proptosis), or causes headaches or facial pain.
  2. Meningiomas: Sphenoid wing meningiomas are slow-developing, non-cancerous brain tumours that develop from the dura over the sphenoid wing (the bone at the base of the skull just behind the eyes). They result in various symptoms, such as pain, visual difficulty, and proptosis. The sphenoid wing is a delicate area with crucial structures nearby, such as the cavernous sinus and optic nerve, which is why precise treatment is critical. This is what makes the treatment for sphenoid wing meningioma such a complex and challenging matter, requiring a high level of expertise.
    Transorbital endoscopic surgery, a less invasive treatment option for sphenoid wing meningiomas, offers direct, precise access to these tumours with minimal disturbance to surrounding tissue. This precision is a key advantage, ensuring the safety and effectiveness of the procedure.
  3. Thyroid eye disease (Graves’ eye disease) is an autoimmune disorder that results in inflammation of the muscles and the nearby fatty tissue of the eye. This type of inflammation can cause protrusion of the eyes and swollen or red eyelids. Decompression is a surgery that involves the resection of soft tissue and bone from behind the eye to create more room in the area.
  4. Optic nerve decompression, which can be done through the transorbital approach, is a significant surgical procedure that aims to relieve pressure on the optic nerve. Increased pressure on the optic nerve may be due to various reasons, such as high intracranial pressure, traumatic injury, or the presence of a tumour.
  5. Sinus lesions: Some patients have very large sinuses, and these can be difficult to access through the nose alone. The transorbital route can be used with the nasal route (multiportal surgery) to help access these difficult-to-reach lesions.

FAQ

Can you remove sphenoid wing meningiomas?

Yes, surgical resection is a potential treatment option because large or symptomatic sphenoid wing meningiomas can be removed or made smaller (debulked). The aim of surgery is to preserve or improve vision, correct proptosis (protruding eye), and remove as much of the tumour as possible.

What are the advantages of transorbital surgery?
  • It is much less invasive than a craniotomy.
  • Quicker recovery time
  • Minimal scarring
  • Fewer post-operative complications compared to open surgery
  • Patients often don’t require post-op ICU
Does the surgery involve a multidisciplinary team effort?

Yes, transorbital surgery involves a multidisciplinary team effort. Surgeons from various fields, such as neurosurgeons, ear, nose and throat surgeons, and in some cases, oculoplastic surgeons, collaborate closely to ensure the best possible outcome for the patient.