Microsurgical resection of anterior clinoidal meningiomas with arterial engulfment: lessons from 2 contrasting cases

Anterior clinoidal meningiomas are among the most complex skull base tumors because of their proximity to the optic apparatus, internal carotid artery (ICA), and its branches. When vessels are engulfed or encased, the difficulty of resection and the risk to the vasculature increase significantly. Surgical management requires balancing maximal resection with neurovascular preservation. The authors present 2 cases with ICA engulfment. The first involved anterior choroidal artery injury managed using collateral assessment, neurophysiological monitoring, and indocyanine green angiography as a surrogate intraoperative balloon test occlusion. The second emphasizes meticulous dissection and progressive debulking to achieve gross-total resection while preserving neurological function. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25169.