• Moshe Attia, Kunal S Patel, Jothy Kandasamy, Philip E Stieg, Henry M Spinelli, Howard A Riina, Vijay K Anand, and Theodore H Schwartz.
• Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
• World Neurosurg. 2013 Dec 1;80(6):e367-73.

ObjectiveTo evaluate the efficacy of combining an endonasal endoscopic skull-base approach and repair with a transcranial orbitozygomatic approach for spheno-orbital meningiomas (SOMs).MethodsThree patients with recurrent SOMs underwent combined orbitozygomatic and endonasal endoscopic surgery. In 2 patients both procedures were done in 1 operation and in 1 patient the endonasal surgery was done 2.5 months after the craniotomy. Extent of resection, complications, morbidity, and mortality were evaluated.ResultsGross total resection was achieved in 1 patient and near total resection in the other 2 patients with tumor left in the cavernous sinus and parapharyngeal space. Two patients suffered cranial neuropathy from the transcranial surgery and the other developed a pseudomeningocele. There were no complications from the endonasal surgery. Patients having combined single setting cranionasal surgery were discharged on day 6 and 8, whereas the patient having only the endonasal component on a later date was discharged on day 2.ConclusionsA combined cranionasal approach involving transcranial orbitozygomatic and endonasal endoscopic approaches is an effective 2-stage surgery for resecting SOMs invading into the sinuses and paranasal compartments. The ability to perform a multilayer closure involving a vascularized nasoseptal flap additionally decreases the risk of postoperative cerebrospinal fluid leak.Copyright © 2013 Elsevier Inc. All rights reserved.

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