Sphenoorbital meningiomas are insidious tumors with slow progression. Even when exophthalmos is not clinically evident, it is always present on preoperative MR imaging. Total resection is not possible due to superior orbital fissure invasion, but subtotal resection (Simpson Grade II) can assure long-term stability due to the nonevolutive nature of most residual tumors. Exophthalmos improves at early radiological follow-up, but may worsen again as time passes.

We report 2 patients who had clinical and neuroimaging signs of spontaneous intracranial hypotension and who developed cerebral sinus venous thrombosis. This sequence of events – known after dural puncture but not in spontaneous intracranial hypotension – was suggested by the change in the pattern of headache, from a postural to a permanent and increasing one. The diagnostic and therapeutic difficulties that this complication raises are discussed.

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This study identifies rebound after NTZ cessation as an association of relapses and high MRI activity.