SPHENOORBITAL MENINGIOMAS: DO TRADITIONAL TRANSCRANIAL APPROACHES HOLD THEIR GROUND AGAINST MINIMALLY INVASIVE STRATEGIES? LITERATURE REVIEW WITH ILLUSTRATIVE CASE.

Background: Sphenoorbital meningiomas (SOMs) represent a relatively rare tumor group with complex anatomical features and considerable morbidity for the patient. Along the decades, numerous approaches have been refined in order to ensure maximal resection and preservation of the structures comprising the intricate anatomy of the orbit. Objective: The aim of this paper is to evaluate the significance of classical transcranial corridors considering the variety of other less invasive approaches to this pathology. Material and methods: A search was performed with all possible combinations of MESH terms such as "Sphenoorbital," "Meningioma", "Transcranial", "Endoscopic Transorbital" using acknowledged medical research databases (Pubmed, ScienceDirect). Studies in English providing insight into the effectiveness of transcranial and endoscopic approaches to SOMs were selected and analyzed. Secondary and tertiary literature sources were additionaly consulted. The case of a patient with sphenoorbital meningioma and reactive hyperostosis referred to and operated in the neurosurgery department of the Emergency County Hospital Târgu Mureş was also included. Results : Despite the implementation of endoscopic resection techniques, transcranial approaches such as the pterional one remain a landmark in the field of sphenoorbital meningiomas. They ensure excellent exposure of the tumor when arising from the lateral and middle sphenoid wing. Moreover, reactive hyperostosis of the surrounding bone and lateral compression of the optic canal can be tackled satisfactorily by approaching the meningioma from the pterion. However, problems occur when the sphenoorbital meningioma originates from the clinoidal process, compressing the optic canal medially and/or inferiorly. In this situations, other approaches should be adopted. Conclusions: Transcranial approaches of sphenoorbital meningiomas have yet to lose their importance, despite the existence of other surgical corridors associated with better esthetic outcomes. A point to be kept in mind is that improvement of symptoms and overall postoperative evolution of the patient are associated not only with the chosen approach, but also with the extent of resection, degree of optic canal compression and extension into the periorbit. [ABSTRACT FROM AUTHOR]