Commentary

Friedrich and colleagues describe a novel approach using frameless stereotaxy and facial incision for reconstruction of a sphenoid defect in a patient diagnosed with neurofibromatosis type I. This approach is less invasive than the extensive coronal incision/intracranial option. Another approach to this lesion would be to use a curvilinear incision extending superiorly from the root of the zygoma, creating a small craniotomy or craniectomy, and then placing the mesh into this region extradurally. Cosmetically, this incision may be less disfiguring because it is posterior to the hairline, unlike the lateral extension of the eyebrow used in this case report.

The technique described in this case report is useful in the treatment of exophthalmos resulting from a sphenoid wing defect. However, we prefer an intracranial approach using frameless stereotaxy to treat cases of fibrous dysplasia/intraosseous meningioma, which have similar presentations. It is important to tailor the approach to the pathology. The authors also mention a minimally invasive approach as appropriate for the problem, but caution should be used in extending this approach to other causes of exophthalmos. This case illustrates the utility of frameless stereotaxy and the corresponding decrease in invasiveness in the correction of skull base defects.