Purpose

In this report, we describe a challenging case of sphenoido-orbital menengioma and management with a multi-disciplinary approach.

---

Methods

A 67-year-old male patient was presented with a history of progressively increasing proptosis in the left eye over 10 years. Previous imaging suggested a diagnosis of spheno-orbital meningioma with extension to cavernous sinus wall and temporal pole dura, sphenorbital bone invasion, and intraorbital extension from the optic canal. Decreased visual acuity, limited ocular motility, exotropia, thinning of the retinal nerve fiber layer on optic coherence tomography and concentric visual field loss on perimetry was noted. The case was discussed on the neuro-oncology board and surgery was recommended before radiosurgery treatment, with collaboration of otorhinolaryngology, ophthalmology and neurosurgery.

---

Results

Under general anesthesia, head secured in a three pin head holder, a neuronavigation system was established. Using an endoscope and endonasal route, the ethmoid bulla and ethmoidal air cells were excised. Progressing posteriorly, anterior wall of sphenoid sinus was removed. The optic nerve was localized with the aid of neuronavigation. The overlying bone was drilled and elevated, achieving decompression of the optic nerve. Subsequently, a linear incision was made over the left eyelid crease, and the intraorbital space was accessed through the superolateral wall of the left orbit under surgical microscope. With careful retraction of the globe, an incision was made to periorbit and the meningioma was debulked. Using transorbital endoscopy guidance, the superior, lateral, and posterior walls of the orbit were further drilled to achieve adequate decompression. Regression of proptosis and increased mobility of left globe was observed on the first postoperative day. Pathology confirmed meningioma and radiosurgery treatment was planned.

---

Conclusion

Due to the anatomical complexity of head region masses, multidisciplinary collaboration among different specialties enhances patient safety and significantly contributes to improved clinical outcomes.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Alperen	Poyraz	Istanbul University, Istanbul Faculty Of Medicine
Mustafa Selim	Sahin	Istanbul University, Istanbul Faculty Of Medicine
Hakan	Kara	Istanbul University, Istanbul Faculty Of Medicine
Levent	Aydemir	Istanbul University, Istanbul Faculty Of Medicine
Mehmet Serhat	Mangan	Istanbul University, Istanbul Faculty Of Medicine
Tugrul Cem	Unal	Istanbul University, Istanbul Faculty Of Medicine

↑ Back to top