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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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Transorbital neuroendoscopic surgery.

Kris S Moe1, Chris M Bergeron, Richard G Ellenbogen

  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington 98195-6161, USA. krismoe@u.washington.edu

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Transorbital neuroendoscopic surgery (TONES) offers a safe and effective minimally invasive approach for challenging anterior and middle skull base pathologies. This technique provides excellent visualization and access for treating conditions like cerebrospinal fluid leaks and tumors.

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Area of Science:

  • Neurosurgery
  • Endoscopic Surgery
  • Skull Base Surgery

Background:

  • Transorbital neuroendoscopic surgery (TONES) addresses challenges in accessing laterally placed or paramedian anterior skull base lesions.
  • TONES enables simultaneous, coplanar visualization and working space above and below the skull base.

Purpose of the Study:

  • To present an anatomic study of TONES.
  • To describe TONES surgical techniques.
  • To analyze the safety and efficacy of 20 TONES procedures for various pathologies.

Main Methods:

  • Sixteen patients underwent 20 TONES procedures for anterior skull base pathology.
  • Conditions treated included cerebrospinal fluid leaks, optic nerve decompression, cranial base fracture repair, and skull base tumor removal.
  • Mean patient age was 44 years, with a follow-up of 6-18 months.

Main Results:

  • No significant complications or treatment failures occurred in the 20 procedures.
  • TONES facilitated treatment for diverse pathologies including CSF leaks, fractures, mass lesions, and tumors.
  • The approach provided up to 4 access ports, ensuring ample exposure for surgical manipulation.

Conclusions:

  • TONES offers safe and effective endoscopic access to the anterior and middle cranial base.
  • These novel TONES approaches expand the minimally invasive options for challenging skull base pathology.