Transorbital neuroendoscopic surgery (TONES) is a group of approaches whose indications are expanding from orbital tumors to more complex skull base lesions. We analyzed the role of the endoscopic transorbital approach (eTOA) for spheno-orbital tumors, reporting the results of our clinical series and of a systematic review of literature. All patients operated from 2016 to 2022 in our Institution for a spheno-orbital tumor through an eTOA were included and a systematic review of literature was performed. Our series consists of 22 patients (16 females, mean age: 57 ± 13 years). Gross tumor removal was achieved in 8 patients (36.4%) after eTOA, and in 11 (50.0%) after a multistaged strategy combining eTOA with the endoscopic endonasal approach. Complications consisted in one chronic subdural hematoma and one permanent extrinsic ocular muscles deficit. Patients were discharged after 2.4 ± 1.3 days. The most common histotype was meningioma (86.4%). Proptosis improved in all cases, visual deficit in 66.6% and diplopia in 76.9%. These results were confirmed by the review of the 127 cases reported in literature. Despite its recent introduction, a significant number of spheno-orbital lesions treated with an eTOA are being reported. Its main advantages are the favorable patient outcome and the optimal cosmetic results, with minimal morbidity and quick recovery. This approach can be combined with other surgical routes or adjuvant therapies for complex tumors. However, it is a technically demanding procedure, requiring specific skills in endoscopic surgery, that should be reserved to dedicated centers.

• EAA is an innovative, promising, safe and effective approach for 3VCPs. • Key of success is surgeon learning curve in endoscopy and patients selection. • With correct indications, EEA gives GTR and morbidity rate similar to other routes. • Clinical, tumoral and anatomical features should be considered for EEA selection.

Background/Objectives: Clivus metastases from distant neoplasms are uncommon occurrences both in clinical practice and the neurosurgical literature. Surgical management is debated, particularly about the role of surgery and the preferable approach. The aim of this study was to report our surgical experience and review the concerning literature. Methods: Our institutional registry was retrospectively reviewed, and patients who underwent surgical treatment for clival metastasis from 1998 to 2023 were included. A PRISMA systematic review of the literature was performed. Results: Four patients were enrolled, and all of them underwent an endoscopic endonasal approach (EEA). Three presented with cranial nerve (CN) VI palsy. The aim of surgery was biopsy in all cases. No complications were reported. Mean overall survival (OS) was 6 ± 1 months. The systematic review retrieved 27 papers reporting 39 patients who underwent the surgical treatment of clivus metastases. Most of them (79.5%) presented with CN palsies, and EEA was the preferred approach in 92.3% of the cases, to perform a biopsy in most patients (59%). Two hemorrhagic complications (5.1%) were reported, and the mean OS was 9.4 ± 5.6 months. Conclusions: Clival metastases are uncommonly observed, in most cases, during advanced stages of oncological disease. The aim of surgery should be the confirmation of diagnosis and symptomatic relief, balancing the risk–benefit ratio in a multidisciplinary context. EEA is the approach of choice, and it should be carried out in experienced tertiary skull base centers.

Background: Patients with intestinal‐type sinonasal adenocarcinoma (ITAC) have an unfavorable prognosis, and new diagnostic and therapeutic approaches are needed to improve clinical management.Methods: Next‐generation sequencing‐based miRNome analysis was performed on 43 ITAC patients who underwent surgical resection, and microRNA (miRNA) data were obtained from 35 cases. Four miRNAs were identified, and their expression levels were detected by reverse‐transcription quantitative polymerase chain reaction and related to the relevant patient outcome. Overall survival and disease‐free survival rates were evaluated through the Kaplan–Meier method and log‐rank test, and multivariate analysis was performed by means of Cox proportional hazard analysis.Results: High levels of miR‐205 and miR‐34c/miR‐449 cluster expression were associated with an increased recurrence risk and, therefore, a worse prognosis. Multivariate analysis confirmed that miR‐205 and miR‐449 were significant prognostic predictors.Conclusions: A high expression of miR‐205 and miR‐449 is independent predictors of poor survival for ITAC patients.