Intraosseous sphenoid wing meningiomas are indolently growing tumors that often present with symptoms related to orbital compression. Since these tumors can extensively involve the anterior and middle cranial fossae by the time they are detected, a frontotemporal craniotomy with mobilization of the temporalis muscle may be necessary for gross total resection. However, since intraosseous sphenoid wing meningiomas tend to grow very slowly, symptomatic relief by decompression of involved structures may be sufficient for management.
Transorbital approaches have recently gained favor among neurosurgeons as a minimally invasive approach to access anterior and middle fossa lesions. The lateral orbitotomy approach makes use of a small incision hidden in a skin crease at the lateral corner of the eye to access the lateral orbital wall and the lesser and greater sphenoid wings. By dividing the lateral canthal ligament, this incision is joined to the palpebral fissure, increasing the overall width of the skin opening. To avoid orbital injury during bony removal, a retractor is used to gently retract the orbital contents, with periodic relaxation.
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