Transorbital Approach to Sphenoorbital Meningiomas: Selected Cases Series

Objective: The purpose of this study was to describe a surgical technique used to treat selected sphenoorbital meningiomas (SOMs) using a transorbital surgical route through a direct upper eyelid crease incision.

Design: A retrospective noncomparative case series was conducted with a description of the surgical technique.

Participants: From 2007 to 2010, 12 patients (11 women, 1 man) with SOMs, which were limited to the lateral orbital wall and roof and not invading any further than the foramen rotundum and anterior clinoid, underwent surgical resection by the described technique. The average age of the patients was 59.5 years (range, 49–73 years). Possibly because of the nature of our referral basis, which receives all orbit-related conditions in our country, most of our patients were sent with variable degrees of unilateral proptosis (range, 2–5 mm; average, 3 mm). Only two patients presented some visual impairment due to compressive optic neuropathy, and none presented with trigeminal symptoms or oculomotor disfunction.

Intervention: Transorbital resection of SOM was successfully attempted in selected cases using a 5.23-cm average incision length made along the upper eyelid crease extended laterally toward the superior edge of the zygomatic bone 1–2 cm posterior to the lateral orbital rim. A self-retaining retractor holds skin and subcutaneous tissues assisting dissection on the lateral orbital rim, making it possible to reach from 1 cm above the frontozygomatic suture to the zygoma's superior edge inferiorly. A single layer of tissue that includes periosteum and the anterior aspect of temporalis facia at the orbital rim is sharply dissected off and reflected anteriorly toward the orbit. Temporalis muscle insertion is exposed such that it can be bloodlessly detached and retracted posteriorly, acquiring full exposure of the true pterion, so that the superficial aspect of the greater sphenoid is fully exposed along with the whole tip of the temporal squama and inferolateral aspect of the frontal bone. Such exposure allows direct burring of meningioma-infiltrated bone so that total resection of the greater sphenoid wing and orbital roof can be reached. The orbitotemporal dural band is identified and transected to reach the base of the anterior clinoid extradurally. This allows clinoid removal, if necessary, and extradural dissection of V1 and V2, which is necessary to lift off the meningioma-infiltrated temporal floor dura. En bloc resection of the dura was performed after opening the dura and dissecting meningioma off the brain tissue using standard microsurgical techniques.

Conclusion: Simpson 1 was achieved in all selected cases using the upper eyelid crease transorbital surgical route. The described technique is suitable to reach satisfactory resection of SOM for selected cases.