Healthcare

Restoring Vision Through Minimally Invasive Skull Base Surgery: A Spheno-Orbital Meningioma Case

NYU Langone Health
NYU Langone Health•Mar 9, 2026

Why It Matters

Minimally invasive trans‑orbital surgery can restore vision quickly and cut recovery time, reshaping standards for skull‑base tumor management.

Key Takeaways

  • •Acute vision loss prompted urgent spheno-orbital meningioma removal.
  • •Transorbital endoscopic approach leveraged pneumatized skull base anatomy.
  • •3D modeling and navigation guided precise tumor resection.
  • •Postoperative vision improved within 24 hours after decompression.
  • •Minimally invasive technique reduced hospital stay to two days.

Summary

The video details a case at NYU Langone where a woman experienced rapid right‑eye vision loss due to a 2.5‑cm spheno‑orbital meningioma compressing the optic nerve. Because the deficit was acute, the surgical team opted for an urgent, minimally invasive resection rather than a traditional craniotomy.

Pre‑operative imaging revealed an unusually pneumatized skull base, with frontal and ethmoid sinuses extending over the orbital roof. Leveraging this anatomy, the team selected a trans‑orbital endoscopic route, collaborating with oculoplastic surgeon Dr. Stella Chung. They fused MRI, CT‑angiogram, and a 3‑D printed model to map a safe corridor, then used intra‑operative navigation to track tumor margins and protect adjacent neurovascular structures.

The patient was discharged on postoperative day two, reporting visual improvement as early as the first postoperative day. Dr. Donado Pacion highlighted that immediate decompression allowed the optic nerve to begin healing, underscoring the efficacy of the approach.

This case illustrates how advanced imaging, multidisciplinary planning, and endoscopic skull‑base techniques can achieve rapid functional recovery while minimizing hospital stay, setting a precedent for treating similar orbital‑intracranial lesions.

Original Description

A woman in her 80s presented to NYU Langone Health with significant vision loss caused by a growing spheno-orbital meningioma compressing her optic nerve. The tumor had extended from the orbit into the middle cranial fossa, approaching the cavernous sinus, making surgical access both complex and critical.
In this case, neurosurgeon Donato R. Pacione, MD, and oculoplastic surgeon Stella Chung, MD, used transorbital neuroendoscopic surgery (TONES)—a minimally invasive approach that provided safe access to the orbital and intracranial compartments while avoiding sinus violation and CSF leak.
The 2.5 cm grade 1 meningioma was fully resected in four hours. The patient’s vision improved significantly by the following day. She was discharged home on day two.
CASE HIGHLIGHTS
✦ Tumor extended from the orbital apex into the middle cranial fossa, compressing the optic nerve
✦ TONES selected over a traditional transcranial approach to minimize CSF leak risk and sinus violation
✦ Complete tumor resection achieved without disturbing the brain
✦ Vision significantly restored by postoperative day one
✦ Patient discharged home on day two
SPECIALISTS FEATURED
Donato R. Pacione, MD — Neurosurgeon, NYU Langone Skull Base Surgery Center
Stella Chung, MD — Oculoplastic Surgeon, NYU Langone
ABOUT NYU LANGONE SKULL BASE SURGERY CENTER
NYU Langone’s Skull Base Surgery Center is a national leader in minimally invasive techniques for complex brain and skull base tumors, including transorbital neuroendoscopic surgery (TONES), endoscopic endonasal surgery, and other advanced cranial base approaches.

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