Transorbital Neuroendoscopic Management of Sinogenic Complications Involving the Frontal Sinus, Orbit and Anterior Cranial Fossa

Sinogenic complications involving the frontal sinus, orbit and anterior cranial fossa are often life-threatening and require prompt surgical intervention. Transnasal endoscopic surgery has remained at the forefront of surgical management of sinogenic complications involving these anatomical regions. However, certain areas involved in pathology of the sinuses either cannot be accessed in this fashion, or endanger critical neurovascular structures when transnasal pathways are employed. Therefore, transorbital neuroendoscopic surgery (TONES) was recently introduced to transgress the limits of the transnasal endoscopic surgery. The access that it provides could add additional surgical pathways for treating sinogenic complications involving the frontal sinus, orbit, and anterior cranial fossa. We describe a prospective series of 13 patients who underwent TONES for the management of various sinogenic complications, including epidural abscess, orbital abscess, fronto-orbital mucocele or mucopyocele, as well as subperiosteal abscess presenting with orbital apex syndrome. The primary outcome measurement was the efficacy of TONES in treating these pathologies with single or multiportal technique. TONES provided effective access to the frontal sinus, orbit, and the anterior cranial fossa. All patients demonstrated postoperative resolution of initial clinical symptoms with well-hidden surgical scars. There were no ophthalmologic complications or recurrence of pathology. Based on our experience, TONES appears to provide a valuable addition to current surgical armamentarium for treating selected complications of sinusitis.