Combined lateral and ventral approach for 360° decompression of an intraosseous suprasellar meningioma encasing the optic nerve

Suprasellar meningiomas present operative challenges because of their involvement with cranial nerves and neurovascular structures. The optimal approach for suprasellar meningiomas encasing the optic nerve remains debated. This video presents a patient with profound vision loss limited to hand motion, arising from a calcified suprasellar meningioma with 360° optic nerve encasement, which was resected via an anterolateral approach with extradural anterior clinoidectomy followed by an endoscopic endonasal approach. Postoperatively, vision improved to 20/30 at 2 months with no recurrence at 2 years. This case highlights the complementary roles of transcranial and endonasal strategies in safely resecting an intraosseous suprasellar meningioma encasing the optic nerve. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25187.