Endoscope-Assisted Resection of an Optochiasmatic Cavernoma via a Supraorbital Craniotomy Through an Eyebrow Incision: Operative Video.

Optochiasmatic cavernomas are rare vascular lesions that may present with acute or progressive visual deficits.1,2 Surgical resection is indicated in symptomatic cases, particularly after hemorrhage, with improved outcomes after gross total resection.3,4 We present the operative video of a 75-year-old woman with acute visual disturbance caused by an optochiasmatic cavernoma (Video 1). After the failure of corticosteroid therapy, surgical resection was performed. A right-sided supraorbital approach via an eyebrow incision was selected (Figure 1) to access the lesion through the nondominant side. Moreover, this controlateral trajectory provided a favorable working corridor to the left retrochiasmatic component while avoiding unnecessary manipulation of the left internal carotid artery. A subfrontal corridor was developed after cerebrospinal fluid release. Microsurgical dissection exposed the right internal carotid artery, optic pathways, and A1 segments of the anterior cerebral arteries (Figure 2). The lesion, identified by dark red coloration of the left optic tract, was progressively resected. Endoscopic inspection revealed a small residual component not visible under the microscope. Following a slight extension of the chiasmatic pia mater opening, the residual lesion was removed, and final endoscopic inspection confirmed macroscopically complete resection. Postoperative magnetic resonance imaging confirmed gross total resection, with bilateral noncompressive subdural collections secondary to cerebrospinal fluid depletion. Histopathological analysis confirmed cavernous malformation. Right visual function recovered, with partial improvement in left visual acuity. This case illustrates the feasibility of the supraorbital approach via an eyebrow incision and highlights the value of endoscopic assistance in identifying and removing the residual lesion beyond the microscopic field of view.