# How I do It: Endoscopic transorbital resection of sphenoid osseous meningioma via the lateral orbital ‘sliding coach door’ approach

## TL;DR

A new endoscopic surgical technique is described for removing a meningioma near the eye and brain, offering better access and recovery.

## Contribution

A novel lateral orbital 'sliding coach door' osteotomy technique is introduced for transorbital resection of sphenoid meningiomas.

## Key findings

- The sliding coach door approach provided adequate working space for tumor resection with minimal soft tissue dissection.
- The technique allowed satisfactory resection of the meningioma with acceptable cosmetic outcomes.
- Residual dural tail remained, requiring future surveillance but not compromising the procedure's success.

## Abstract

A 63-year-old presented with reduced left visual acuity and V1 sensation. Imaging demonstrated left sphenoid osseous meningioma narrowing superior orbital fissure with intracranial extension to superior temporal gyrus.

Endoscopic transorbital approach utilising novel lateral orbit ‘sliding coach door’ osteotomy performed. Lateral canthal incision with lateral canthal ligament division mobilises and decompresses globe infero-medially. Osteotomy performed, tethered by temporalis. Osteotomy slides postero-laterally creating working space lateral to inferior and superior orbital fissures.

This technique requires reduced soft tissue dissection and facilitates reconstruction. Adequate working space enabled satisfactory resection with residual dural tail requiring future surveillance. Cosmesis was satisfactory.

The online version contains supplementary material available at 10.1007/s00701-025-06484-w.