Hyperostotic Invasive Meningioma of the Sphenoid Ridge Surgical Considerations: 2-Dimensional Operative Video

Hyperostotic invasive sphenoid ridge meningiomas are a distinct and recognized entity.1-4 They are characterized by extensive bone involvement and expansive "en plaque" intradural extension.3,5 The goal of this surgery is improving and preserving the visual function and ocular motility while esthetically correcting and reconstructing the exophthalmos and temporal deformity.4,5 The surgery includes radical removal of the involved bone of the sphenoid ridge, orbital walls, and middle fossa floor, in addition to the "en plaque" dural and periorbital involvement and intradural extension.3,5,6 Early decompression of the optic nerve and orbital elements allows preventing visual function deterioration and yields frequent improvement. Thorough planned reconstruction can be achieved by molding a malleable mesh to the patient's skull before the extensive bone removal. Careful orbital wall reconstruction allows one to achieve a good postoperative cosmesis and prevent enophthalmos.4 We demonstrate the principles of this surgery through 2 cases of 46-year-old and 53-year-old women. The first case demonstrates the importance of middle fossa extensive drilling of involved bone and reconstruction while the second case demonstrates the visual decompression and postoperative improvement. The patients consented to the surgeries and publication of their images.