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Spheno-orbital meningiomas (SOMs) are surgically challenging lesions characterized by tumor infiltration and hyperostosis of the sphenoid wing and orbit. Surgical treatment requires tumor resection, drilling of hyperostotic bone, orbital decompression and skull base reconstruction. Traditionally, reconstruction has been performed either free hand or as a delayed second-stage procedure, often resulting in suboptimal skull and facial symmetry. Single-stage resection with immediate CAD/CAM-assisted reconstruction offers a feasible alternative but requires meticulous preoperative planning and a standardized surgical workflow.

In this retrospective study of 34 patients with SOMs, we present our institutional standardized protocol for preoperative CAD/CAM planning and single-stage tumor resection with immediate skull reconstruction technique. Clinical, functional and radiological outcomes were also assessed.

Exopthalmos was the predominant presenting symptom. Gross-total resection was achieved in 73.5% of cases, resulting in a reduction of exophthalmos in 85% of patients and improvement of visual acuity in approximately 70%. However, postoperative amaurosis occurred in 8.8% and transient diplopia in 55.9%. CAD/CAM implants demonstrated appropriate intraoperative fit without major implant-related complications and with preservation of orbital and facial symmetry.

Single-stage resection with immediate CAD/CAM-assisted skull reconstruction for SOMs is feasible, safe and reproducible. The standardized workflow by combining tumor resection and patient-specific reconstruction within a single-stage procedure may offer practical advantages in the overall surgical pathway.