Simultaneous two-team transorbital neuroendoscopic approach for sphenoid wing meningioma

Background: Surgery for skull base lesions is often time-consuming. In this research, we aimed to improve the efficiency of transorbital neuroendoscopic surgery (TONES) for skull base lesions, specifically sphenoid wing meningiomas, by reducing operative time without compromising patient safety or surgical outcomes. Methods: A simultaneous two-team surgical approach was developed, combining medial endonasal and lateral transorbital techniques. One team performed medial endonasal optic canal decompression, while the other conducted a lateral transorbital middle cranial fossa approach through a superior eyelid incision. Teams worked concurrently, pausing only during critical stages of medial optic nerve decompression to prevent interference. Results: The two-team approach demonstrated a significant reduction in operative time compared to sequential techniques. This method allowed for a comprehensive tumour resection and optic nerve decompression within a single procedure, achieving minimal morbidity and a rapid recovery for patients. Conclusion: The simultaneous two-team approach enhances the efficiency of TONES for sphenoid wing meningiomas and similar skull base lesions. Contribution: This technique offers a practical and safe solution to streamline complex multiportal surgeries while maintaining optimal clinical outcomes.