Gender Authorship Trends in the Transorbital Neuroendoscopic Surgery Literature

Purpose: Transorbital neuroendoscopic surgery (TONES) is a relatively new technique allowing minimally invasive access to the skull base through advanced interdisciplinary teamwork. Recent analyses have suggested potential narrowing of the gender gap in workforce diversity and research productivity among areas of skull base surgery, including component specialties of oculofacial plastic surgery, rhinology, and neurosurgery.1–4 The purpose of this study was to quantify the contributions of authors by gender within the developing literature of TONES over time. Methods: This retrospective observational study analyzed all articles published on TONES subject matter utilizing the PubMed search terms of highest output yield: transorbital endoscopic. Only original human research studies pertaining to TONES were included. Data reviewed included article type, year, and the gender of each article’s first and senior author. Results: Of three hundred seventy-seven articles reviewed, 253 articles spanning from years 2001 to 2025 met criteria for inclusion in the analysis. Overall females were underrepresented in the TONES literature, holding 40 (15.8%) of the first authorship roles and 14 (5.5%) of the senior authorship roles. Female first authorship in TONES has consistently increased over time from 2015 (first, 7.7%; senior, 0.0%), to 2020 (first, 11.5%; senior, 9.6%), and to 2025 (first, 18.3%; senior, 5.1%) ([ Fig. 1 ]). In a sub-analysis of same sex first/senior authorship in TONES, the rate of male/male authorship dropped from 92.3% (2015) to 82.7% (2020) to 78.9% (2025) ([ Fig. 2 ]). Simultaneously, the rate of the more diverse combination of female/male authorship rose from 7.7% (2015) to 16.0% (2025). Combinations pertaining to females as senior authors did not benefit the same increase over time. Conclusion: Despite a notable increase in female authorship over the history of TONES research, females remain underrepresented within the TONES literature, particularly in regard to senior authorship. Promising strides toward gender parity have been made in female representation as first authors and the growing trend toward mixed gender teams. These findings corroborate prior trends in the skull base surgery literature as a whole, suggesting a need for greater attention to promoting diversity in the scholarly contributions in our field. Fig. 1 Fig. 2 Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany