Osteomyelitis Following Infrabrow Orbitotomy for Clinoid Meningioma Resection

The transorbital neuro-endoscopic surgical (TONES) approach to resection of tumors involving the superior orbit and skull base describes a minimally invasive technique that avoids larger craniofacial exposure. Described advantages include reduced brain retraction when compared to more extensive cranial approaches, decreased operative time, faster postoperative recovery, and improved cosmetic outcomes. Reported adverse outcomes of this approach include supraorbital nerve injury, eyebrow alopecia, visible scarring, and postoperative soft tissue infection. We describe the case of a patient who underwent infrabrow orbitotomy for a clinoid meningioma and developed orbital osteomyelitis postoperatively. To the best of our knowledge, osteomyelitis of the frontal bone following infrabrow transorbital craniotomy has not been previously reported.