This groundbreaking, minimally invasive surgery is performed through the eye socket, thus eliminating the removal of the top of the skull to reach the brain. "By performing surgery through the eye socket, we eliminate the need for a full craniotomy, gain equivalent or better access to the front of the brain, and eliminate the large ear-to-ear scar associated with major brain surgery," said Doctor Chris Bergeron, assistant professor of surgery, Division of Head and Neck Surgery, at UC San Diego Health System. "This novel technique is also critical to protecting major blood vessel structures and nerves, such as the optic and olfactory nerves."

In the TONES procedure, the surgeons make a small incision behind or through the eyelid. A tiny hole is then made through the paper-thin bone of the eye socket to reach the brain. This pathway permits repairs to be made without lifting the brain. The TONES approaches protect the nerves for sight, the nerves for smell, as well as the carotid and ophthalmic arteries.

"This approach has opened a new field of brain surgery," said study investigator, Doctor Kris Moe, professor of surgery and chief of the Division of Facial Plastic and Reconstructive Surgery. "The advantages to this transorbital approach are many, including less pain and faster recovery time for the patient."

Moe, who pioneered TONES in 2005, said the technique builds on the nasal approach, but offers increased maneuverability and visibility for the surgical teams which usually require four sets of hands. In a traditional craniotomy, a large portion of skull bone is removed.

With TONES, the area of bone removed is only two to three centimeters. The operating time is much shorter since the skull does not need to be repaired and there is no need to close a large incision. Patients have undergone the procedure to repair cerebral spinal fluid leaks, optic nerve decompression, repair of cranial base fractures and removal of tumors.; Source: University of Washington