2026 Poster Presentations
P003: GENDER AUTHORSHIP TRENDS IN THE TRANSORBITAL NEUROENDOSCOPIC SURGERY LITERATURE
Daniel B Azzam, MD, MBA1; Yosur G Alsulaiman, MD1; Edward C Kuan, MD2; Lilangi S Ediriwickrema, MD1; Jeremiah P Tao, MD, FACS1; Seanna R Grob, MD, MAS1; 1Division of Oculofacial Plastic and Orbital Surgery, Gavin Herbert Eye Institute, University of California Irvine, Irvine, California, U.S.A.; 2Departments of Otolaryngology, Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, U.S.A.
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%) (Figure 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) (Figure 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.
Conclusions: 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.
References
1. Azzam DB, Meller LLT, Oca M, Vagefi MR, Tao JP. Career Paths, Practice Location, and Scholarly Contributions of American Society of Ophthalmic Plastic and Reconstructive Surgery Fellowship Graduates, 2000-2021. Ophthalmic Plast Reconstr Surg. 2025;41(3):258-265. doi:10.1097/IOP.0000000000002797
2. Behmer Hansen RT, Behmer Hansen RA, Gold JL, et al. A Decade of Global Skull Base Researchers: Gender Data from over 2,700 Abstract Authors in the Journal of Neurological Surgery Part B: Skull Base. J Neurol Surg B Skull Base. 2022;85(1):57-66. doi:10.1055/a-1978-9487
3. Halderman AA, Rao A, Desai-Markowski S, et al. Gender and authorship trends in rhinology, allergy, and skull-base literature from 2008 to 2018. Int Forum Allergy Rhinol. 2021;11(9):1336-1346. doi:10.1002/alr.22793
4. Gervasio KA, Sklar BA, Nguyen AX, Wu AY. Gender Authorship Trends in the Ophthalmic Plastic and Reconstructive Surgery Literature. Ophthalmic Plast Reconstr Surg. 2022;38(2):160-165. doi:10.1097/IOP.0000000000002013
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