An oculoplastic perspective on Transorbital Neuroendoscopic Surgery: Anatomical corridors and clinical applications

Transorbital neuroendoscopic surgery (TONES) has adopted an increasingly prominent role as a minimally invasive technique for the management of orbitocranial pathology. It can be applied to a range of conditions, from intraorbital lesions to complex tumors that cross the boundaries between the orbit and cranial fossa. The primary approaches include the superior lid crease incision and lateral retrocanthal incisions, with other alternatives including the precaruncular and inferior transconjunctival approaches. This review will examine the role of the oculoplastic surgeon in multidisciplinary TONES procedures. Cadaveric and clinical studies have defined anatomical corridors and demonstrated the technical feasibility and functional outcomes of providing access to the anterior and middle cranial fossae. Adjunctive maneuvers, such as a lateral orbitotomy or creation of extra-orbital portals, can be performed to improve surgical freedom and access. The choice of technique can be tailored to the type and location of pathology and surgical objectives regarding diagnosis and resection.