Neuro-Orbital Disease

This chapter explores diseases that straddle the orbito-cranial interface, with an emphasis on sphenoid wing meningioma, fibrous dysplasia, and orbital apical syndromes. Such pathologies can present with impaired visual functions, periorbital swelling and/or pain, proptosis and chemosis, and cranial nerve signs. Whilst spheno-orbital meningiomas are benign, their management presents particular challenges, and requires multi-specialty collaboration. The indications for surgery, both orbital and neurosurgical, and radiotherapy, depend on disease location, rate of tumour progression, and extent of visual impairment. Fibrous dysplasia is primarily a bone disease and can cause severe facial deformity, pain and visual impairment due to compression of the optic nerve by optic canal narrowing or aneurysmal bone cyst. Treatment, either surgical or systemic with bisphosphonates or denosumab, needs a multidisciplinary approach. Multiple myeloma and solitary extramedullary plasmacytomas are hematological malignancies needing radiotherapy or chemotherapy, but with relatively poor prognosis. Finally, orbital apex, superior orbital fissure, and cavernous sinus syndromes are discussed, being distinct entities but sharing common causes.