Fig. 5.

Proposal for a new treatment allocation algorithm for the management of spheno-orbital meningiomas (SOMs). Invasion of lateral orbital compartment is the “conditio sine qua non” for the possible proposal of an endoscopic superior eyelid approach in the management of an SOM. When both craniotomic and transorbital corridors may be chosen from an anatomical point of view, a series of factors ( yellow boxes ) may help in determining surgical aim and most appropriate surgical corridor. When a planned subtotal resection is the objective, the analysis of performance indexes such as KPS and mRS should be the outcome that deserves to be primarily considered; in cases where a GTR is considered safely achievable, Simpson grade 0/I should be the objective. GTR, gross total resection; KPS, Karnofsky Performance Status; mRS, modified Rankin Scale; STR, subtotal resection.