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Retinal and Optic Nerve Integrity After Endoscopic Transorbital Skull Base Surgery Assessed by Optical Coherence
Jessica Matas1,2, Alberto Di Somma2,3,4, Vanessa Liras1
1Institut Clínic of Ophthalmology (ICOF), Hospital Clínic de Barcelona, University of Barcelona, Barcelona , Spain.
Neurosurgery
|November 24, 2025
Summary
The endoscopic transorbital approach (ETOA) is safe for the optic nerve and retina, showing no significant injury in patients undergoing skull base surgery. This minimally invasive technique preserves visual function, supporting its use in neurosurgery.
Area of Science:
- Neurosurgery
- Ophthalmology
- Medical Imaging
Background:
- The endoscopic transorbital approach (ETOA) offers minimally invasive skull base access.
- Concerns exist regarding potential subclinical optic nerve or retinal injury due to the orbital trajectory.
- Objective neuro-ophthalmic assessment is crucial for evaluating ETOA safety.
Purpose of the Study:
- To assess the structural safety of the endoscopic transorbital approach (ETOA) on the optic nerve and retina.
- To evaluate subclinical injury using high-resolution optical coherence tomography.
- To focus primarily on patients without orbital involvement.
Main Methods:
- 16 patients from 41 ETOA cases (2017-2024) with 12-month follow-up imaging were analyzed.
- Group A (n=10) had no orbital involvement; Group B (n=6) had orbital/optic nerve involvement.
- Spectral-domain optical coherence tomography measured macular ganglion cell layer (GCL) and peripapillary retinal nerve fiber layer (RNFL) thickness.
Main Results:
- No surgery-related structural or functional deterioration was observed in any patient.
- Group A showed non-significant changes in GCL and RNFL thickness within physiological limits.
- Group B demonstrated RNFL thinning, attributed to pre-existing conditions, with stable or improved visual function.
Conclusions:
- The endoscopic transorbital approach (ETOA) does not cause subclinical retinal or optic nerve injury.
- ETOA demonstrates structural and functional safety, especially in patients without orbital involvement.
- Findings support the neuro-ophthalmic safety of ETOA and warrant further prospective studies.
