Endoscopic Transorbital Approach for Sphenoorbital Meningiomas: First Colombian Case Reports

Introduction: Tumors involving the sphenoidal wings may present with major involvement of the orbit and the middle cranial fossa. These locations represent a surgical challenge, requiring careful selection of the surgical approach. When involving the orbit or its fissures, meningiomas may present with proptosis, restriction of eye movements and decline of visual acuity. Endoscopic transorbital surgery has become an effective and less invasive surgical technique for the treatment of orbital and middle cranial fossa tumors, demonstrating a safer profile and same oncological results as a conventional approach. We present the first two cases of transorbital approach for management of sphenoorbital meningiomas in Colombia.

Case Reports: An otherwise healthy 38-year-old female presented with a 2-year history of headache and right eye proptosis. She underwent a previous partial resection via transcranial surgery of an orbital extraconal WHO-I meningioma demonstrated by pathology. The symptoms persisted after surgery and follow up imaging studies revealed progressive growth of the residual mass.

A 46-year-old female with a history of migraine presented with headache and nausea. She had a brain magnetic resonance imaging (MRI) that revealed a sphenoorbital mass with primary involvement of the middle cranial fossa. No ophthalmological signs of orbital compromise were noted.

Both patients underwent endoscopic transpalpebral transorbital resection of the lesion. Intraoperative findings in both patients showed sphenoidal hyperostosis. Complete macroscopic resection of the lesion was achieved in both cases. There were no intraoperative complications. Both lesions were confirmed to be meningiomas by pathology. Measurement of eye position by Hertel exophthalmometry in the first patient, pre- and postoperatively, showed resolution of proptosis. Postoperative MRI showed gross total resection in both cases. Headache intensity was measured with the pain visual analog scale (VAS) before and 2 months after surgery, showing improvement postoperatively.

Conclusion: The endoscopic transorbital approach is a useful surgical technique for the treatment of sphenoidal meningiomas with or without orbital involvement. It is a less invasive procedure, allowing compete surgical resection of the disease, while maintaining a low rate of complications. It has shown improvement in proptosis, visual acuity, and headache relief. Our two cases add to the growing global literature demonstrating these benefits and set a precedent in a developing country. This surgical technique should be routinely considered in the therapeutic arsenal for the different pathologies of the orbit and middle cranial fossa.

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Artikel online veröffentlicht:
12. Februar 2021