Superior eyelid endoscopic transorbital approach for spheno-orbital tumor: First reported case in Brazil

Background: Spheno-orbital meningiomas (SOMs) are rare intracranial tumors arising predominantly from the greater wing of the sphenoid and extending through the middle cranial fossa into adjacent neurovascular corridors, including the cavernous sinus, superior orbital fissure, and optic canal. These lesions often cause significant morbidity due to hyperostotic bone proliferation and compression of orbital contents, resulting in proptosis, cranial neuropathies, and visual impairment. We report the first Brazilian case of a spheno-orbital lesion managed through a superior eyelid endoscopic transorbital approach (ETOA). Case description: A 41-year-old woman presented with complete visual loss in the left eye and progressive oculomotor dysfunction. Imaging revealed a large hyperostotic mass invading the orbit, cavernous sinus, and skull base. Orbital decompression and tumor biopsy were performed using ETOA through the upper eyelid crease. The approach provided safe extradural access to the lateral skull base with minimal brain manipulation. Postoperative imaging confirmed adequate decompression, and longitudinal follow-up confirmed a favorable prognosis. Histopathological analysis revealed a World Health Organization Grade I meningothelial meningioma. Conclusion: This case highlights the feasibility and safety of ETOA for orbital decompression and lesion sampling in complex SOMs and represents the first reported use of this technique in a Brazilian public hospital.