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Studies involving human or cadaveric TONES and endoscopic transorbital approaches were reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten studies met inclusion criteria, comprising cadaveric as well as human subjects. Virtual-reality and cadaveric models revealed that 10\u201311 mm of globe displacement provides adequate surgical freedom, whereas sustained retraction beyond approximately 15 mm results in steep rises in intraocular and intra-orbital pressure posing a higher risk of orbital compartment syndrome. Clinical reports link prolonged retraction to transient or permanent mydriasis, ocular hypotony, decompression retinopathy, and visual loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Orbital retraction is central to TONES but is the principal driver of ocular morbidity. Based on the available evidence, retraction should be dynamic, gentle, and intermittent, with globe displacement generally limited to 10\u201312 mm. Apex-directed focal pressure should be avoided, and continuous monitoring of pupil and intraocular pressure is essential. Multidisciplinary protocols are recommended to standardize safe retraction practices while preserving the advantages of TONES.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-026-06921-4","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T13:14:09Z","timestamp":1780578849000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dangers of orbital retraction in transorbital neuroendoscopic surgery"],"prefix":"10.1007","volume":"168","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0635-3275","authenticated-orcid":false,"given":"Ayushi","family":"Agarwal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica Y.","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh","family":"Selva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"6921_CR1","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1097\/IOP.0000000000003091","volume":"42","author":"QM Austria","year":"2026","unstructured":"Austria QM, Stevens SM, Coombs A, Lelli GJ Jr, Schwartz TH, Godfrey KJ (2026) Ophthalmic outcomes of transorbital endoscopic skull base surgery. 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