Telecanthal approach for meningiomas in the ethmoid and sphenoid sinuses

Abstract

In three cases involving meningiomas in the ethmoid and sphenoid sinuses, transbasal spreading of the interocular distance (telecanthal approach) was used for tumor removal and reconstruction of the skull base. This telecanthal approach involves 1) bilateral en bloc removal of the superior lateral rim of the orbit, the nasal bone, and the posterior lateral wall of the orbit; 2) detachment of the medial canthal ligaments; and 3) spreading of the interocular distance. This approach provides a wide working space beneath the anterior half of the midline skull base, and needs neither a facial incision nor significant retraction of the brain. The surgical technique and its modification are described. The discussion focuses not only on comparisons with other techniques, but on the indications for this approach. Meningiomas originating in the paranasal sinuses are rare; a brief review of the literature concerning the clinicopathological features and pathogenesis is also given.

Extracranial primary and secondary meningiomas

“…Most of the reported cases involving the upper airway represent secondary extension from an intracranial lesion 8,10,11,13,17 . Extracranial meningiomas arising from the sinonasal tract or temporal muscle with no evidence of an association with an intracranial tumour (also called heterotopic, ectopic, or extracalvarial) are rare 2,3,9,10,13,15,22 , and most of the reported cases were described before modern radiographic imaging techniques were available to exclude intracranial tumours. There is a growing consensus that primary extracranial meningiomas are truly extracranial, lacking any detectable intracranial mass or 'dural enhancement' by radiologic techniques.…”

Primary sphenoid sinus meningioma resection via transnasal transsphenoid approach: A case report

“…A search of PubMed® (using the key words “meningioma” and “sphenoid sinus”) revealed four reports of meningioma involving the sphenoid sinus (Table 1). 4,8,10,11 An additional report of 30 extracranial sinonasal tract meningiomas included only two cases originating purely from the sphenoid sinus. 3…”