Management of Aggressive Recurrent Meningioma Using a Combined Transfacial-Pterional Approach

Skull base meningiomas, although histologically benign, can exhibit locally aggressive behavior, particularly when arising from the sphenoid wing. Their potential to infiltrate bone and extend extracranially into the orbit, infratemporal fossa, and facial soft tissues significantly increases surgical complexity and recurrence risk. Complete resection in these cases requires wide anatomical exposure and multidisciplinary planning to preserve critical neurovascular structures while achieving oncologic control. We present the case of a woman with a recurrent sphenoid wing meningioma extending into the middle cranial fossa, orbit, masticator space, and premaxillary region. A single-stage combined transfacial (Weber-Ferguson) and extended pterional approach was performed, allowing for gross total resection with preservation of function and anatomy. Histopathology confirmed a WHO Grade I meningothelial meningioma. Postoperative imaging demonstrated complete resection, and the patient remains neurologically intact under continued surveillance. This case highlights the role of tailored craniofacial approaches in managing complex, multicompartmental skull base meningiomas with extracranial extension.