Montefiore Einstein Comprehensive Skull/Cranial Base Center continues  to push the envelope with minimally invasive brain tumor surgery performed  through the eye–a procedure known as transorbital neuroendoscopic surgery (TONES)–advancing a completely incisionless TONES approach and leading TONES education and training for physicians from around the world, as well as evolving other minimally invasive approaches via all endoscopic and open corridors to manage complex skull base pathology. We are one of the first and few centers in the nation to routinely offer TONES, which unites the endoscopic approach of pituitary surgery with microscopic neurosurgical tumor resection. This technique allows for minimally invasive access to very complex tumors through the eye, at times not requiring any incisions, while preserving the patient's vision.   

In 2023, Vijay Agarwal, MD, Director of Montefiore Einstein Skull/Cranial Base Tumor Center, published one of the first textbooks to describe the TONES approach in detail, highlighting our Center’s innovations and expertise. We are one of the highest volume skull base centers in the region and, based on our experience and thought leadership in the field, we have launched an education campaign this past year offering webinars and formal courses to train and teach other academic institutions and physicians around the world about the TONES approach. 

Our dedicated, multidisciplinary TONES team is led by Vijay Agarwal, MD, from Neurosurgery, Patrick Colley, MD, from Otorhinolaryngology, Anne Barmettler, MD from Ophthalmic, and Nigar N. Ahmedli, MD from Facial Plastic Surgery (Oculoplastic Surgery). Our team of world-renowned neurosurgeons, otorhinolaryngologists, oculoplastic surgeons, plastic surgeons, medical and radiation oncologists, critical care specialists, endocrinologists, and neuro-ophthalmologists continues to grow with the addition of a fellowship-trained facial-plastic surgeon from the Department of Otorhinolaryngology this past year. Together, we are able to routinely provide complex brain tumor surgery for the most challenging cases at a level that few centers in the nation are able to match, thereby continuing to set new standards in TONES.