Transorbital Neuroendoscopic Surgery: A Comprehensive Review for Managing Intracranial Lesions with Orbital Access

Transorbital Neuro Endoscopic Surgery (TONES) stands at the forefront of neurosurgical innovation, providing a transformative approach for accessing intricate intracranial vascular lesions within the orbit. The versatility of TONES extends beyond orbital confines, reaching into challenging territories such as the anterior cranial fossa, making it a promising option for lesions extending into the orbital region. This review explores the historical evolution, technical intricacies, and clinical applications of TONES, emphasizing its role in managing vascular lesions. The genesis of TONES aimed to overcome limitations inherent to traditional surgical approaches, offering equivalent visibility while minimizing invasiveness and complications associated with open skull base surgery. Introduced in 2007 by Moe, TONES has evolved into a minimally invasive access corridor, expanding the horizons of neurosurgery through refined instrumentation and advanced surgical techniques. In the context of intracranial vascular lesions, particularly arteriovenous malformations and cerebral cavernomas, TONES exhibits advantages over conventional methods. Its minimally invasive nature, reduced morbidity, and superior cosmetic outcomes position it as a viable alternative. However, meticulous planning, coordination, and adherence to sterile protocols are imperative. Preoperative imaging, intraoperative navigation, and customized bone defects tailored to lesion specifics contribute to procedural success. Complications associated with TONES procedures demand systematic categorization for proactive risk mitigation. From eyelid necrosis to trigeminal hypoesthesia, anticipating and addressing potential pitfalls require a multifaceted approach. Meticulous dissection techniques, intraoperative monitoring, and postoperative assessments are crucial components of risk reduction. In conclusion, TONES represents a paradigm shift in neurosurgical approaches to intracranial vascular lesions, showcasing its adaptability and precision.