Surgery stands as the primary treatment for spheno-orbital meningiomas, following a symptoms-oriented approach. We discussed the decision-making process behind surgical strategies through a review of medical records from 80 patients who underwent surgical resection at the University of Naples Federico II. Different surgical approaches were employed based on the tumor\'s location relative to the optic nerve\'s long axis, categorized into lateral (type I), medial (type II), and diffuse (type III). We examined clinical, neuroradiological, surgical, pathological, and outcome factors. Proptosis emerged as the most frequent symptom (97%), followed by visual impairment (59%) and ocular motility issues (35%). Type I represented 20%, type II 43%, and type III 17%. Growth primarily affected the optic canal (74%), superior orbital fissure (65%), anterior clinoid (60%), and orbital apex (59%). The resection outcomes varied, with Simpson grades I and II achieved in all type I cases, 67.5% of type II, and 18% of type III. Recurrence rates were highest in type II (41.8%) and type III (59%). Improvement was notable in proptosis (68%) and visual function (51%, predominantly type I). Surgery for spheno-orbital meningiomas should be tailored to each patient, considering individual characteristics and tumor features to improve quality of life by addressing primary symptoms like proptosis and visual deficits.

En plaque meningioma is a rare type of meningioma characterized by an infiltrative nature, sheet-like growth, and at times invading the bone. We report here a case of en plaque meningioma. The patient was a 66-year-old woman presenting with headache and painful bilateral proptosis. Cerebral magnetic resonance imaging revealed a bilateral en plaque meningioma showed as a bilateral hyperostotic of greater wing sphenoid bone associated with bilateral thickening and enhancement of the dura in the anterior temporal area and the retroclival region invading bilaterally the cavernous sinus, the prechiasmatic portion of the optic nerve, and the lateral rectus muscle of the orbit through the superior orbital fissure causing bilateral exophthalmia. Due to invasion of the cavernous sinus and the orbital apex, a subtotal but extensive removal combined with bony decompression of the cranial nerves at the superior orbital fissure and optic canal followed by adjuvant radiotherapy frequently produces good functional and cosmetic results, and over a 3-year period, follow-up magnetic resonance imaging scans showed no obvious signs of recurrence.

UNASSIGNED: To report our experience with patient specific implants for one-step orbit reconstruction following hyperostotic SWM removal and to describe the evolution of the technique through three surgical cases. Methods: Three cases of one-step SWM removal and orbit reconstruction are described. All cases are given consecutively to describe the evolution of the technique. Hyperostotic bone resection was facilitated by electromagnetic navigation and cutting guides (templates). Based on a 3D model, silicone molds were made using CAD/CAM. Then PMMA implant was fabricated from these molds. The implant was adjusted and fixed to the cranium with titanium screws after tumor removal. Results: Following steps of the procedure changed over these series: hyperostotic bone resection, implant thickness control, implant overlay features, anatomic adjustments, implant fixation. The proptosis resolved in all cases. In one patient the progressive visual acuity deterioration was recognized during the follow-up. No oculomotor disturbances and no tumor regrowth were found at the follow-up.
UNASSIGNED: CAD/CAM technologies enable creation of implants of any size and configuration, and thereby, to increase the extent of bony resection and lower the risk of tumor progression. The procedure is performed in one step which decreases the risk of postoperative morbidity.

This case report discusses a unique instance of pulsatile tinnitus (PT) caused by a rare type of intracranial dural arteriovenous fistula (DAVF) located in the sphenoid wing (SW) region, with PT being the sole presenting symptom. The patient initially received multiple misdiagnoses and sought medical attention at various hospitals before being correctly diagnosed. Imaging studies revealed the DAVF\'s presence in the SW region, which led to the patient\'s referral to interventional radiology/neurology, although she chose conservative observation without surgical intervention. Remarkably, the patient\'s PT spontaneously ceased after 30 months without any apparent cause, and follow-up imaging confirmed the absence of DAVF-related abnormalities. The case highlights the importance of considering DAVF as a potential cause of PT, even when there are no evident abnormalities in proximity to the auditory apparatus. It also emphasizes the need for otolaryngologists to extend their examination to include regions beyond the temporal bone, such as the sphenoid bone and orbital areas, when PT is the exclusive symptom. The case underscores the significance of early detection and intervention for DAVFs, as they can lead to debilitating complications, despite the rare occurrence of spontaneous symptom resolution in this case.

A 9-year-old female mixed-breed dog presented for treatment of a presumed sphenoid-wing meningioma. Clinical signs included tonic-clonic seizures lasting <1 min, which had started 3 months previously. The physical examination results were unremarkable. An eccentrically located neoplastic cystic structure in the right sphenoid bone region suggestive of a meningioma and peritumoural brain oedema was observed in pre-operative magnetic resonance imaging (MRI). Prior to surgery, a three-dimensional (3D) patient-specific pointer (PSP) was designed using computed tomography (CT) images and computer-aided 3D design software. After a targeted approach and exposure of the lateral part of the right temporal lobe by a craniectomy guided by the 3D-PSP, complete macroscopic piecemeal resection of the meningioma could be performed using endoscopy-assisted brain surgery. Post-operative MRI confirmed complete excision of the tumor. Anticonvulsive therapy was discontinued after 90 days, and the dosage of anticonvulsants was tapered 2 weeks after surgery. At a follow-up examination 225 days post-operatively, recurrence of seizures was not observed, and the absence of tumor recurrence was confirmed by a repeat MRI examination. To the best of our knowledge, this is the first report in veterinary medicine describing a successful resection of a sphenoid-wing meningioma using a 3D-PSP. 3D-PSP-assisted craniectomy may be a surgical option for some canine skull-based tumors, such as sphenoid wing meningiomas.

We present a-49-year old female presenting headache and progressive right eye visual loss in the last 6 months. Magnetic resonance imaging showed a large clinoidal meningioma on the right side, invading the superior, lateral and medial aspects of the cavernous sinus, the optic canal, and the clinoidal segment of the internal carotid artery (ICA). A cranio-orbital approach was performed. The anterior clinoid process was removed extradurally to achieve devascularization of the anterior clinoidal meningioma, followed by the peeling of the middle fossa to decompress V2 and open the superior orbital fissure. We open the dura in a standard fronto-temporal flap to access the lower portion of the skull base allowing retractorless dissection. We complete the removal of the anterior clinoid process and optic strut through an intradural approach. It allows safer dissection of the clinoidal segment of the ICA and avoids its injury by adherent and hard consistency tumor. Intraoperative neurophysiological monitoring, sharp dissection, and avoiding the use of bipolar coagulation when dissecting the cavernous sinus are essential to minimize the risk of cranial nerve injury. We also like to point that cranial nerve deficit caused by surgical manipulation without primary lesion of the nerve can be recovered postoperatively. The link to the video can be found at: https://youtu.be/ozUCsnUGxyM .

UNASSIGNED: To report a case of multilayered intraocular hemorrhage at the posterior pole as a complication of transorbital neuroendoscopic surgery.
UNASSIGNED: Our patient underwent an uncomplicated endoscopic transorbital resection of a left sphenoid wing meningioma. In the immediate post-operative period, the patient reported blurred vision of her left eye, and dilated fundus examination demonstrated multilayered hemorrhages at the posterior pole. No intracranial hemorrhage was identified on post-operative imaging. Due to persistent subnormal visual acuity and non-clearing hemorrhage over several weeks of follow-up, a pars plana vitrectomy with peeling of the internal limiting membrane was performed to clear the hemorrhagic component obscuring the macula.
UNASSIGNED: We report the first case of multilayered intraocular hemorrhages at the posterior pole, mimicking Terson syndrome, in the absence of intracranial hemorrhage or elevated intracranial pressure as a complication of transorbital surgery.

UNASSIGNED: En-plaque-meningioma (EPM) is characterized by its flat growth along the bony contour. It accounts for 2-9% of all meningiomas. Very few grade II or III EPM cases were reported. Surgical resection of sphenoid wing EPM is especially challenging as the tumour tends to invade the cavernous sinus, and/or the orbit, and their neurovascular structures. Consequently, tumours in such locations have a higher rate of recurrence. We report the clinical course and management of a patient suffering a second recurrence of grade II EPM. The clinical course of grade II EPM, and the management of multiple recurrences of EPM are scarcely reported in the literature.
METHODS: A 53-year-old male with a history of three previous surgeries for EPM presented with decreased vision in the right eye. Brain magnetic resonance imaging (MRI) showed progression of a sphenoid wing meningioma invading the left optic nerve, indicating a second recurrence of the tumour.
UNASSIGNED: We reviewed the literature discussing the clinical course of grade II EPM, and cases suffering multiple recurrences. Only a few cases were found with varying clinical course and management. In our case, surgical intervention was necessary to save the patient\'s vision. A modified orbitozygomatic craniotomy was performed. A small residual tumour invading the cavernous sinus was left for treatment with stereotactic radiosurgery.
CONCLUSIONS: Sphenoid wing EPM is challenging pathology to manage, especially grade II tumours which are rarely encountered. Multimodality treatment with surgery and radiotherapy offers EPM patients the best chance of treatment.

Background  Medial sphenoid wing meningiomas (MSWMs) account for approximately 20% of all meningiomas that are known for their critical relation to neurovasculture structures. Objective  The purpose of this study is to examine the relation between the maximum diameter of the MSWM medial to the anterior clinoidal line (AC line) and surgical outcome. Methods  This is a retrospective cohort study investigating all surgically resected MSWM cases at our institution over 10 years. The patients were divided into groups A and B based on the average ratio between the maximum medial extension of the MSWM from the AC line to the maximum diameter of the tumor, that is, value I = 0.42 (group A ≤ 0.42 and group B > 0.42). And into groups C and D based on the average medial extension of the tumor, that is, 14 mm (group C ≤ and D group D > 14 mm). These measurements were correlated with patients\' demographics, preoperative symptoms, and postoperative assessment. Results  Among 150 patients, 51patients had MSWM that fulfilled the inclusion criteria. Among them, 76.47% were females with a median age of 48 years (standard deviation [SD] = 47.75 ± 15.11). Also, 92% of the cases were World Health Organization (WHO) grade I. The follow-up period was 0.5 to 10 years. Among them, 40% of group C had gross total resection (GTR), whereas 43% in group D. In group B, 70% had GTR, whereas 48% had GTR in group A. None of the patients developed statistically significant postoperative complications. There is no statistically significant difference in the risk complication with medial extension in all groups. Conclusion  The degree of medial extension of MSWM from the AC line has no statistically significant correlation with major postoperative complications, extent of resection, or clinical outcome.

\"Cementifying fibroma\" is a benign tumor of the fibroblastic tissue containing masses of cementum-like calcified tissue, usually occurring between the third and fourth decades. Cementifying-ossifying fibromas are rare non-odontogenic, fibro-osseous tumors of the periodontal ligament that arise from the mesodermal germ layer3. We report a 12-year-old male child, who presented with a swelling in the left temporal region near the angle of the left eye. These non-neoplastic, locally destructive tumors present as an osseous lesion involving the mandible, maxilla, zygoma, paranasal sinuses, orbit, and rarely the petromastoid regions. The preoperative diagnosis was not clear even with CT and MRI, and, hence, all fibro-osseous lesions were considered as differential diagnosis. The lesion was surgically resected completely, and the histology confirmed it as a cementifying fibroma. According to the WHO classification, this is a variant of cementifying fibromas, which represent a subgroup of cementomas, that is, fibro-osseous lesions containing cementum. Histologically, these are fibrous tissues with calcified structures resembling bone and cementum. Cranioplasty was done simultaneously, with successful clinical results.