| Summary: | Abstract Introduction Spheno-orbital meningiomas are characterized by bone invasion with extensive hyperostosis and possible encroachment into the orbit, infra-temporal fossa, and/or the cavernous sinus that render total surgical excision challenging. The surgical technique utilized is a key factor facilitating complete resection and hence improvement of proptosis and accompanying visual symptoms. Methods This is a retrospective study of twenty-two patients (including 4 recurrent cases) with meningioma en-plaque, presenting with hyperostosis and proptosis. We describe the surgical approaches used, technique, and extent of resection in addition to postoperative outcome. Results In twenty patients, the pterional approach was used, while two patients were operated on via the mini orbito-zygomatic approach. Total resection of the tumor was achieved in 10 cases (45.5%), subtotal in 6 (27.3%), partial in 5 (22.7%), and in 1 case, injury to the internal carotid artery lead to premature termination of surgery. Seventeen patients (77.3%) had improvement of proptosis, 2 (9.1%) had partial improvement, and 2 (9.1%) had no improvement at 3 months of follow-up. Post-operative morbidities include cerebrospinal fluid leak, infection, and hydrocephalus, each occurred in one (4.5%) different case. Conclusions Proper drilling of the lateral and superior orbital walls with excision of any intra-orbital soft tissue components is all key points for better surgical resection and clinical regression of proptosis. However, factors such as extension of the hyperostosis to the infra-temporal fossa or medial orbital wall, tumor invasion of the cavernous sinus, or adherence of tumor to the orbital muscles, prevent total excision.
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