Endoscopic Transorbital Approach for Spheno-Orbital Tumors: Case Series and Systematic Review of Literature

Transorbital neuroendoscopic surgery (TONES) is a group of approaches whose indications are expanding from orbital tumors to more complex skull base lesions. We analyzed the role of the endoscopic transorbital approach (eTOA) for spheno-orbital tumors, reporting the results of our clinical series and of a systematic review of literature. All patients operated from 2016 to 2022 in our Institution for a spheno-orbital tumor through an eTOA were included and a systematic review of literature was performed. Our series consists of 22 patients (16 females, mean age: 57 ± 13 years). Gross tumor removal was achieved in 8 patients (36.4%) after eTOA, and in 11 (50.0%) after a multistaged strategy combining eTOA with the endoscopic endonasal approach. Complications consisted in one chronic subdural hematoma and one permanent extrinsic ocular muscles deficit. Patients were discharged after 2.4 ± 1.3 days. The most common histotype was meningioma (86.4%). Proptosis improved in all cases, visual deficit in 66.6% and diplopia in 76.9%. These results were confirmed by the review of the 127 cases reported in literature. Despite its recent introduction, a significant number of spheno-orbital lesions treated with an eTOA are being reported. Its main advantages are the favorable patient outcome and the optimal cosmetic results, with minimal morbidity and quick recovery. This approach can be combined with other surgical routes or adjuvant therapies for complex tumors. However, it is a technically demanding procedure, requiring specific skills in endoscopic surgery, that should be reserved to dedicated centers.