Purpose

To evaluate safety and outcomes of endoscopic endonasal orbital surgery and transorbital neuroendoscopic surgery (TONES) performed in multidisciplinary collaboration between orbit, ENT/skull-base, and neurosurgery.

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Methods

Thirty-one consecutive cases were retrospectively reviewed (2015–2026; 31 patients, mean age 51 years, range 10–84) across four groups: intraconal/extraconal orbital tumours, sinonasal malignancy, TONES for sphenoid wing meningioma, and other benign sinonasal tumors with orbital extension.

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Results

Intraconal/extraconal orbital tumours (n=8; 7 cavernous hemangiomas, 1 schwannoma) all presented with signs of compressive optic neuropathy. Seven were resected via purely endoscopic medial orbitotomy with en bloc excision; one required adjunct open orbitotomy. All achieved reversal of afferent pupillary defect and visual field normalisation with same-day discharge. Mean operative time was 244 minutes (range 141–329). Complications included transient diplopia (n=3), retained surgical patty requiring retrieval (n=1), and enophthalmos (n=1). Sinonasal malignancy (n=11): oculoplastics provided orbital protection and tumour resection. Complications included transient diplopia (n=2), nasolacrimal obstruction requiring dacryocystorhinostomy (n=3), and intraoperative cerebrospinal fluid leak (n=2). TONES for sphenoid wing meningioma (n=3; 1 primary, 2 re-operations): mean operative time 670 minutes (range 485–834); mean admission 6 days (range 2–10). Other benign lesions (n=9): orbital protection and assisted resection with no optic neuropathy and minor transient complications.

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Conclusion

Growing multidisciplinary collaboration between orbit, skull-base, and neurosurgery has enabled safe expansion of endoscopic orbital surgery across diverse pathology. Building a dedicated orbital and skull-base program expands surgical reach while minimising morbidity, with each subspecialty contributing distinct expertise toward improved patient-centred outcomes.

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Additional Authors

First name	Last name	Base Hospital / Institution
Vivian	Yin	University of British Columbia
Arif	Janjua	University of British Columbia
Andrew	Thamboo	University of British Columbia
Peter	Gooderham	University of British Columbia
Serge	Makarenko	University of British Columbia

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