Minimally Invasive Lateral Orbital Wall Approach for Sphenocavernous Meningioma Resection with Endoscope Assistance

Sphenocavernous meningiomas are technically challenging tumors that, in addition to cavernous sinus neurovascular involvement, frequently affect the optic nerve and carotid artery. The surgical goal generally consists of complete resection of the extracavernous portion of the tumor, whereas the cavernous sinus tumor can be treated with postoperative radiation if necessary. Traditional techniques include the pterional or orbitozygomatic approach that requires substantial soft tissue, scalp, and temporalis muscle mobilization along with temporal and frontal lobe manipulation. A keyhole craniotomy performed through a lateral orbitotomy provides a minimally invasive option with excellent tumor exposure that obviates the need for soft tissue trauma or brain manipulation. Use of an endoscope can provide further visualization for more expansive tumors. This Video 1 presentation demonstrates a case of an 84-year-old woman with a growing sphenocavernous meningioma and abducens palsy who underwent a minimally invasive lateral orbital wall approach for resection of the extracavernous tumor. There were no intra- or perioperative complications, and the patient was discharged home on postoperative day 1. This technique is a useful addition to the armamentarium of surgeons who treat these complex tumors.