# Bilateral cranioorbital foramina (Hyrtl foramina): crucial anatomical findings in the management of giant olfactory groove meningioma - a case report and literature review

## TL;DR

This case report highlights the challenges of managing a large brain tumor due to rare anatomical features that increase surgical risks.

## Contribution

The paper presents a rare case of bilateral Hyrtl foramina complicating meningioma treatment and emphasizes the need for multidisciplinary planning.

## Key findings

- Bilateral Hyrtl foramina can complicate embolization and surgery for olfactory groove meningiomas.
- The tumor was supplied by multiple arteries, requiring meticulous preoperative planning.
- Multidisciplinary approaches are essential for optimal outcomes in such complex cases.

## Abstract

Presence of bilateral cranio-orbital foramina, AKA Hyrtl foramina is rare yet existing. They carry the risks of retinal artery emboli due to reflux embolization for the neurovascular interventionalists, navigating complexities in olfactory groove meningioma management. A 59-year-old woman with progressive frontal lobe syndrome presented a large olfactory groove meningioma primarily supplied by bilateral sphenopalatine arteries together with bilateral anterior cerebral arteries, necessitating risky preoperative embolization and meticulous resection. This case underscores the intricate nature of vascular supply in frontal skull base tumors, emphasizing the need for multidisciplinary approaches, thorough preoperative planning, and detective research to optimize treatment outcomes.