**5. Clinical case**

#### **5.1 Case 1**

A 58 year old female patient, who operated on 9 years ago for the cavernous sinus meningioma, had an MRI that revealed a recurrence tumor extending into the middle fossa, sphenoid sinus. A pterional approach was performed and exposure of the middle fossa was obtained. An anterior clinoidectomy was performed first. Wide drilling of the bone of the anterior middle fossa was done to remove as much of the tumoral bony infiltration and hyperostosis as possible. The fascia of

the pterygoid muscles was exposed and the SOF, Muller muscle, V1 and V2 were skeletonized. A Maxillary strut was drilled and opened the sphenoid sinus between the V1 and V2 corridor. In addition, an incision was made on the posterior border of the Muller's muscle with preserving the zygomatic nerve and transposed anteriorly in order to enlarge the anterior medial triangle. Tumor in the sphenoid sinus was removed under seeing of the endoscope visualization (**Figure 7**).
