Systematic review and meta-analysis of endoscopic transorbital approach for skull base and orbital lesions

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Neurosurgical review Published May 13, 2026 Medically reviewed May 13, 2026 Study authors: Arend Rudolfh Batista, Peroni Bruno Zilli, Ribeiro Filipe Virgilio, da Silva Mezzari Marcos Henrique… PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider ETOA for skull base and orbital lesions with low reported complication rates in this meta-analysis.

This systematic review and meta-analysis examines the endoscopic transorbital approach (ETOA) as a surgical modality for patients with skull base and orbital lesions. The analysis included 269 patients who underwent ETOA as the sole surgical technique. Follow-up duration was 27.6 ± 15.1 months across the included studies.

The meta-analysis reports specific complication rates for secondary outcomes. CSF leak occurred in 1% of cases (95% CI: 0.00 to 0.04). Wound infection was observed in 3% (95% CI: 0.01 to 0.07). Other complications included ptosis in 4% (95% CI: 0.00 to 0.14), diplopia in 6% (95% CI: 0.01 to 0.14), and medial gaze palsy in 9% (95% CI: 0.04 to 0.18).

Visual outcomes showed improvement in 47% of cases (95% CI: 0.22 to 0.73) while visual dysfunction occurred in 1% (95% CI: 0.00 to 0.04). Transient facial numbness was reported in 16% (95% CI: 0.09 to 0.25). Mortality was 0% (95% CI: 0.00 to 0.02). The authors conclude that ETOA is a safe and promising technique for managing a wide range of skull base and orbital lesions.

The authors acknowledge that future prospective and comparative studies are needed to refine indications and validate long-term efficacy. Funding or conflicts of interest were not reported. The certainty of the evidence is not explicitly graded in the source text.

Study Details

Study typeMeta analysis

Sample sizen = 5

EvidenceLevel 1

Follow-up15.1 mo

PublishedMay 2026

PMID42120790

View Original Abstract ↓

Endoscopic techniques have enabled minimally invasive approaches in neurosurgery, providing shorter recovery times and favorable outcomes. Among these, the endoscopic transorbital approach (ETOA) has emerged as a versatile surgical modality. Despite the growing body of evidence, complication rates associated with ETOA have not yet been systematically evaluated. We systematically searched PubMed, Embase, Scopus, and Web of Science up to March 2026. We included studies enrolling ≥ 5 patients who underwent ETOA as the sole surgical modality to treat both skull base and orbital lesions, providing data on early or long-term complications. A single-group meta-analysis was performed using a random-effects model with 95% confidence intervals. Heterogeneity was assessed with the I² statistic and further explored through Baujat plots and sensitivity analyses. A total of 11 observational studies, comprising 269 patients, were included. Overall, 21 different pathologies were reported. Meningioma represented the most frequent lesion (60.6% of cases), followed by schwannoma (12.0%), cavernous hemangioma (4.6%), and glioma (2.7%). Mean follow-up was 27.6 ± 15.1 months. CSF leak was observed in 1% (95% CI: 0.00 to 0.04, I² = 46.5%), and wound infection was observed in 3% (95% CI: 0.01 to 0.07, I²=0%). Ptosis occurred in 4% (95% CI: 0.00 to 0.14, I²=79.4%) and diplopia occurred in 6% (95% CI: 0.01 to 0.14, I²=68.9%). Medial gaze palsy occurred in 9% (95% CI: 0.04 to 0.18, I²=8.8%). Improvement in visual function was seen in 47% (95% CI: 0.22 to 0.73, I²=88.7%). Visual dysfunction occurred in 1% (95% CI: 0.00 to 0.04, I²=48.6%). Transient facial numbness occurred in 16% (95% CI: 0.09 to 0.25, I²=35.0%). Mortality was 0% (95% CI: 0.00 to 0.02, I²=28.7%). ETOA is a safe and promising technique for managing a wide range of skull base and orbital lesions. Future prospective and comparative studies are needed to refine indications and validate its long-term efficacy.