Endoscopic endonasal resection of a large recurrent tuberculum sellae meningioma with vascular adherence.

Tuberculum sellae meningiomas often compress the optic apparatus and encase the ACA-ACom complex, making approach selection challenging. This video demonstrates endoscopic endonasal resection of a large, recurrent, tuberculum sellae meningioma with severe adherence to the ACA-ACom complex. A transplanum-transtuberculum corridor provided direct access to the dural base, enabling early tumor devascularization and meticulous dissection of microvasculature to the optic nerves, pituitary stalk, and hypothalamus. Unroofing the optic canal facilitated early optic nerve decompression, reducing the risk of neural injury during tumor manipulation. Multilayer skull base reconstruction achieved watertight closure. Gross-total resection was achieved without ischemic sequelae, and postoperative visual function improved significantly. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25148.