A surgical team in Singapore has achieved a medical milestone by successfully removing a 2.5cm brain tumour through a patient’s eye socket. The procedure, known as transorbital neuroendoscopic surgery (TONES), marks the first time this minimally invasive technique has been used locally to excise such a growth.
The patient, 38-year-old Teong Wen Han, underwent the eight-hour operation in November. Mr. Teong, a learning and development manager, had been diagnosed with the tumour following a seizure on Oct 9 that resulted in a car accident on the Central Expressway. Prior to the incident, his only noted symptom was a recurring morning headache, which he had previously attributed to caffeine withdrawal.
A New Surgical Corridor
The tumour was located at the base of the skull, positioned behind the right eye and in close proximity to the optic nerve and essential blood vessels. Traditional open skull surgery, which requires removing a section of the skull to reach such areas, carries risks of significant tissue disruption and potential long-term side effects, such as facial asymmetry resulting from muscle wasting.
By opting for TONES, the team—comprising neurosurgeons Dr. Jensen Ang and Associate Professor Ang Beng Ti, an ophthalmologist, and an ear, nose and throat (ENT) specialist—accessed the brain through tiny incisions in the eye socket. This approach allowed surgeons to navigate a “very deep and narrow hidden corridor” using an endoscope, which provided a live video feed of the surgical field.
Recovery and Outlook
Following the successful surgery, Mr. Teong was discharged after three days without any neurological or eye complications. While he has been weaned off his anti-seizure medications, he has spent the subsequent months relying on public transport, as he was required to stop driving for one year. Once he receives medical clearance, he is expected to be able to return to driving.
Frequently Asked Questions
What is TONES?
TONES stands for transorbital neuroendoscopic surgery. This proves a minimally invasive technique where surgeons access the brain through tiny incisions in the eye socket rather than opening the skull.
Why was this technique chosen for Mr. Teong?
The surgical team chose TONES to avoid the potential complications of traditional open skull surgery, such as facial asymmetry. Mr. Teong specifically requested the procedure due to concerns regarding these visible long-term effects.
How did the team ensure the patient’s vision remained safe?
The surgical team included an ophthalmologist who monitored the patient’s pupils throughout the surgery to ensure the optic nerve was not damaged. The use of an endoscope allowed the team to keep the optic nerve and other critical structures in clear view during the entire process.
How do you think the integration of 3D-printed surgical rehearsals will change the landscape of high-risk neurosurgery in the coming years?
