Endoscopic endonasal approach for tuberculum sellae meningioma with optic canal involvement: standard technique for optimal visual outcomes

Anterior skull base meningiomas often cause visual decline by compressing the optic apparatus. The authors present a tuberculum sellae meningioma with optic canal involvement treated via an endoscopic endonasal approach (EEA). Early devascularization, stepwise detachment, and sharp dissection preserved surrounding neurovascular structures and perforating arteries. Optic canal drilling enabled complete removal, and multilayer reconstruction ensured watertight closure. Gross-total resection was achieved without complications. Visual acuity improved from 0.7 to 1.2, with resolution of visual field defect. This case highlights the EEA as a standard technique for optimal visual outcomes in anterior skull base meningiomas with optic canal involvement. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25176.