Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. The state of the art of skull base meningiomas accounts for both transcranial, or high, and endonasal, or low, routes. A comprehensive review of the pertinent literature was performed to address the surgical strategies and outcomes of skull base meningioma patients treated through a transcranial approach, an endoscopic endonasal approach (EEA), or both. Three databases (PubMed, Ovid Medline, and Ovid Embase) have been searched. The review of the literature provided 328 papers reporting the surgical, oncological, and clinical results of different approaches for the treatment of skull base meningiomas. The most suitable surgical corridors for olfactory groove, tuberculum sellae, clival and petroclival and cavernous sinus meningiomas have been analyzed. The EEA was proven to be associated with a lower extent of resection rates and better clinical outcomes compared with transcranial corridors, offering the possibility of achieving the so-called maximal safe resection.

The transorbital route has been proposed for addressing orbital and paramedian skull base lesions. It can be complemented by further marginotomies, as per “extended-transorbital approach” and combined with others ventro-basal approaches featuring the concept of “multiportal surgery”. Nevertheless, it cannot address some anatomical regions like the clinoid, carotid bifurcation and the Sylvian fissure. Therefore, we propose a combined transorbital and a supraorbital approach, attainable by a single infra-brow incision, and we called it “Uniportal multicorridor” approach. The aim of our study is to verify its feasibility and deep anatomical targets through a cadaveric study. Anatomic dissections were performed at the Laboratory of ICLO Teaching and Research Center (Verona, Italy) on four formalin-fixed cadaveric heads injected with colored neoprene latex (8 sides). A stepwise dissection of the supraorbital and transorbital approaches (with an infra-brow skin incision) to the anterior tentorial incisura, clinoid area, lateral wall of the cavernous sinus, middle temporal fossa, posterior fossa, and Sylvian fissure is described. We analyzed the anatomic areas reached by the transorbital corridor dividing them as follow: lateral wall of the cavernous sinus, middle temporal fossa, posterior fossa, and Sylvian fissure; while the anatomic areas addressed by the supraorbital craniotomy were the clinoid area and the anterior tentorial incisura. The described uniportal multi-corridor approach combines a transorbital corridor and a supraorbital craniotomy, providing a unique intra and extradural control over the anterior, middle, and posterior fossa, tentorial incisura and the Sylvian fissure, via an infra-brow skin incision.

• The transorbital approach combining eyebrow incision and crescent-shaped craniotomy increases the surgical freedom to access the anterior and middle skull-base. • The technic allows the use of both endoscope and microscope. • The concept is at the crossroad between the supraorbital keyhole and endoscopic trans-orbital approach.

Background: Thoracic schwannomas are benign nerve sheath tumors that can cause neurological and respiratory symptoms depending on their location and extension. The optimal surgical approach remains debated, particularly regarding resection extent, complication rates, and postoperative morbidity. Methods: This retrospective multicenter study analyzed 106 patients treated between 2011 and 2024, classifying tumors according to the Eden system and comparing surgical strategies. Surgical variables, including operative time, blood loss, resection extent, recurrence rates, and complications classified by Clavien–Dindo, were analyzed. Results: Eden I and II schwannomas were treated with laminectomy (LCT) or hemilaminectomy (HLCT) and transpedicular approaches (TPD), achieving high gross total resection (GTR) rates with minimal complications. Eden III dumbbell tumors benefited from a combined neurosurgical–thoracic approach (LCT + VATS), which resulted in higher GTR rates (100% vs. 62%, p < 0.01) and lower dural complications compared to neurosurgical resection alone. Eden IV extraforaminal schwannomas were best managed with VATS, which was associated with lower intraoperative blood loss (p = 0.018), shorter surgical duration (p = 0.027), and reduced postoperative complications compared to open thoracotomy. Our findings confirm that minimally invasive techniques, particularly VATS and combined neurosurgical–thoracic approaches, optimize tumor resection while reducing morbidity. However, feasibility depends on institutional resources and multidisciplinary collaboration. Conclusions: This study provides a stratified comparison of surgical approaches tailored to Eden classification, aiming to identify the most effective and least morbid strategies for each lesion type. Future prospective studies should validate these findings, integrating preoperative functional assessments and long-term follow-up to better stratify surgical risk, personalize operative planning, and refine surgical decision making for thoracic schwannomas.

Ependymomas are commonly classified as low-grade tumors, although they may harbor a malignant behavior characterized by distant neural dissemination and spinal drop metastasis. Extra-CNS ependymoma metastases are extremely rare and only few cases have been reported in the lung, lymph nodes, pleura, mediastinum, liver, bone, and diaphragmatic, abdominal, and pelvic muscles. A review of the literature yielded 14 other case reports metastasizing outside the central nervous system, but to our knowledge, no studies describe metastasis in the paravertebral muscles. Herein, we report the case of a 39-year-old patient with a paraspinal muscles metastasis from a myxopapillary ependymoma. The neoplasm was surgically excised and histologically and molecularly analyzed. Both the analyses were consistent with the diagnosis of muscle metastases of myxopapillary ependymoma. The here-presented case report is first case in the literature of a paraspinal muscles metastasis of myxopapillary ependymoma.