Transorbital Neuroendoscopic Approaches - Historical and Tactical Review of Orbital Corridors: A Scoping Review

Sep 29, 2026

Transorbital neuroendoscopic surgery (TONES) is presented as a minimally invasive route to intracranial access using transorbital or transcutaneous entry points, enabling open or endoscope-assisted procedures for anterior and middle skull base and intraorbital pathologies. A scoping review screened 363 studies and selected those detailing transcutaneous or transconjunctival transorbital surgical techniques in peer-reviewed settings. Four transcutaneous transorbital approaches are synthesized, including eyelid-crease and transconjunctival variants, with emphasis on historical origins, indications, contraindications, and outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Transorbital neuroendoscopic surgery (TONES)

Methods

Search strategy

Data extraction and analysis

Study screening criteria

Results

Four transorbital approaches

Superior eyelid crease approach

Article published online: 2025-02-24 94 Original Article THIEME Transorbital Neuroendoscopic Approaches: Historical and Tactical Review of Orbital Corridors: A Scoping Review Rose Fluss 1 Muhammed Amir Essibayi 1 KiChang Kang 1 Daniel Popoola 1 Dileep D. Monie 1 Patrick Colley 1 Vijay Agarwal 1 1 Department of Neurological Surgery, Monteﬁore Medical Center, Leo M. Davidoff, Bronx, New York, United States J Neurol Surg B Skull Base 2026;87:94–100. Address for correspondence KiChang Kang, MD, Department of Neurological Surgery, Monteﬁore Medical Center, Leo M. Davidoff, Bronx, NY 10467, United States (e-mail: kkang@monteﬁ[ore.org](ore.org)). Abstract Keywords ► endoscopic neurosurgery ► minimally invasive ► transorbital approach ► neurosurgery Introduction The orbit is a useful corridor underutilized by the neurosurgical community. The aim of this manuscript is to describe this well-established approach in the neurosurgeon’s tool box. Methods Ascoping review of363articles containingtransorbital neuroendoscopic surgical approaches were reviewed by two independent reviewers for inclusion in this report. Results Discussed here are the four transcutaneous transorbital approaches, including the superior eyelid crease (SLC), and upper eyelid approaches, lateral (retrocanthal) transorbital approach, inferior (preseptal) transconjunctival approach, and the medial (transcaruncular) orbitotomy approach. Conclusion This practical review will highlight the surgical approaches, historical origins, indications, and contraindications of all the orbital corridors to the cranium. Introduction Transorbital neuroendoscopic surgery (TONES) has emerged as a minimally invasive approach for accessing the intracranium. By utilizing either a transorbital or transcutaneous entry point, surgeons can perform open or endoscope-assisted procedures on various skull base and intraorbital pathologies. The evolution of both techniques and technology has allowed the expansion of indications from initially orbital lesions to now include tumors, vascular lesions, and other pathologies throughout the anterior and middle cranial skull base. Transcutaneous transorbital approaches, including the suprabrow, superior eyelid crease (SLC), and upper eyelid approaches, utilize small incisions and dissection planes superﬁcial to the periorbita for bone ﬂap elevation of the orbital roof or lateral wall. Transconjunctival transorbital techniques, such as the preseptal, retroseptal, and transcutaneous transconjunctival approaches, allow access by received September 13, 2024 accepted December 16, 2024 article published online February 24, 2025 DOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.1055/a-2525-5851.](10.1055/a-2525-5851.)[ ](10.1055/a-2525-5851.)[ISSN](ISSN 2193-6331.)[ 2193-6331.](ISSN 2193-6331.) discretely progressing between the conjunctiva and orbital septum. Methods Search Strategy A comprehensive literature search was conducted on PubMed database on January 14, 2024, to identify relevant articles describing transorbital neuroendoscopic surgical approaches. The following search terms and Medical Subject Headings (MeSH) were used in various combinations: “transorbital,”“superior eyelid crease,” “orbitotomy,” “transconjunctival,”“retrocanthal,” “transcaruncular,” “neuroendoscopic surgery,”“TONES,” “minimally invasive,” “skull base.” The search was limited to articles published in the English language. Studies were included if they met the following criteria: (1) Described surgical techniques, indications, contraindications, or complications of transcutaneous or transconjunctival transorbital © 2025 . The Author(s) . This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited.([https://creativecommons.org/licenses/by/4.0/](https://cre

FAQs

What is the goal of the review on transorbital neuroendoscopic approaches?

The review aims to describe transorbital approaches and summarize their historical origins, tactical use, indications, and contraindications for orbital corridors extending to the cranium.

How were studies selected for the scoping review?

A PubMed search on January 14, 2024 screened 363 articles. Included studies described surgical techniques, indications, contraindications, or complications, involved human or cadaveric subjects, provided detailed procedural/anatomical information, and were peer-reviewed.

Which transorbital approaches are discussed in the results?

The review discusses four transcutaneous transorbital approaches: superior eyelid crease (SLC) and upper eyelid approaches, lateral (retrocanthal) transorbital approach, inferior (preseptal) transconjunctival approach, and medial (transcaruncular) orbitotomy approach.

Sep 29, 2026

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