How I do It: Endoscopic transorbital resection of sphenoid osseous meningioma via the lateral orbital ‘sliding coach door’ approach

Abstract

Background

A 63-year-old presented with reduced left visual acuity and V1 sensation. Imaging demonstrated left sphenoid osseous meningioma narrowing superior orbital fissure with intracranial extension to superior temporal gyrus.

Method

Endoscopic transorbital approach utilising novel lateral orbit ‘sliding coach door’ osteotomy performed. Lateral canthal incision with lateral canthal ligament division mobilises and decompresses globe infero-medially. Osteotomy performed, tethered by temporalis. Osteotomy slides postero-laterally creating working space lateral to inferior and superior orbital fissures.

Conclusion

This technique requires reduced soft tissue dissection and facilitates reconstruction. Adequate working space enabled satisfactory resection with residual dural tail requiring future surveillance. Cosmesis was satisfactory.