Orbital osteosarcoma masqueraded as hyperostotic meningioma

Osteosarcomas of the head and neck regions represent a rare subtype of primary bone malignancy; those that arise in the orbit are extremely uncommon and can present difficulties for the diagnosis and complicate surgical planning. We report a challenging case of orbital osteosarcoma that masqueraded as a more commonly seen hyperostotic sphenoorbital meningioma. Obtaining the correct preoperative diagnosis is crucial for this highly malignant disease, which requires aggressive treatment and planning. Complete surgical excision is necessary for successful outcomes, while chemotherapy and radiation therapy as adjuncts to surgery may be of survival benefit in high-risk patients.