Spheno-Orbital Meningiomas: Results

Spheno-orbital meningiomas (SOMs) are complex lesions that arise from the sphenoid ridge and tend to spread along multiple nearby sites such as the orbit, anterior and middle cranial fossa, cavernous sinus, and temporal and infratemporal fossa. Traditionally, SOMs have been treated by craniotomies (e.g., pterional, extended pterional, pretemporal approach), sometimes enlarged by means of skull base osteotomies (e.g., cranio-orbital or fronto-temporo-orbito-zygomatic approach). However, given the considerable complexity and extension at presentation, a microsurgical complete removal is often impossible, or it is obtained at the expense of non-negligible morbidity and complications. In this setting, the recent introduction of endoscopic transorbital approaches (eTOAs) represented a novelty in the treatment of this complex pathology. The aim of the chapter is to critically compare these two techniques (i.e., craniotomy vs. endoscopic transorbital approaches), providing the results in terms of extent of resection, complications, and functional outcomes according to an up-to-date literature review, along with the senior authors’ long-standing experience.