SURGICAL MANAGEMENT OF A SPHENOID WING EN PLAQUE MENINGIOMA WITH SIGNIFICANT INTRAORBITAL EXTENSION VIA FTOZ CRANIOTOMY– A CASE REPORT

Abstract

Background: Sphenoid wing en plaque meningiomas with intraorbital extension pose a significant surgical challenge due to invasion of the orbital apex and proximity to neurovascular structures. The frontotemporal orbitozygomatic (FTOZ) craniotomy is the standard approach, requiring careful balance between maximal resection and functional preservation. Case Presentation: A 67-year-old male patient of Indian descent with 3 months of progressive left eye watering and blurred vision. Examination revealed left proptosis and no pupillary defect. MRI revealed a left sphenoid wing en plaque meningioma with significant intraorbital extension and hyperostosis. The patient underwent FTOZ craniotomy with total intracranial and near total intraorbital tumor excision along with ophthal team to preserve the optic nerve. Results: Histopathology confirmed WHO Grade I transitional meningioma. Postoperatively, the patient had immediate visual loss that improved to counting fingers within one week with steroid therapy. Postoperative CT brain revealed pneumocephalus with postoperative changes and no tumor bed bleed. The patient was discharged neurologically stable. Conclusion: The FTOZ approach remains crucial for managing these complex sphenoorbital tumors. A "maximal safe resection" strategy that intentionally preserves neural structures while achieving near-total resection can yield excellent functional outcomes. This case report highlights the importance of a multidisciplinary approach for optimal patient care. Longterm followup is essential given the potential for late recurrence.