Transorbital endoscopic resection of hyperostotic sphenoid wing meningioma: when the orbit becomes the corridor

Background

Sphenoid wing meningiomas are common skull base tumors that often present surgical challenges due to their proximity to critical neurovascular structures and frequent association with hyperostotic bone. While transcranial approaches remain the standard for resection, they are associated with higher morbidity and longer recovery. The transorbital neuroendoscopic approach (TONES) has emerged as a minimally invasive alternative for select cases. Observation: A 64-year-old woman presented with a one-year history of headache and dizziness, without visual or oculomotor deficits. Imaging revealed a well-circumscribed, contrast-enhancing right sphenoid wing meningioma with associated hyperostosis of the greater sphenoid wing and anterior skull base. The lesion was resected using a transorbital endoscopic approach via a 1 cm superior eyelid crease incision. The hyperostotic bone was drilled to expose the lesion, which was then removed in a piecemeal fashion. Gross-total resection was achieved without complications. The patient was discharged on postoperative day one without neurological deficits, and remained asymptomatic at three months, with no radiologic evidence of recurrence.