Tuberculum Sella Meningioma with Clinoidal and Planum Extension

A 63-year-old man presented with severe left visual loss secondary to large tuberculum sella meningioma extending into clinoidal region and planum sphenoidale. Given the tumor complexity, a two-stage procedure was planned: left fronto-orbital approach with extradural anterior clinoidectomy, followed 3 days after endoscopic endonasal approach. This video illustrates the advantages and limitations of transcranial and endonasal approaches for complex tuberculum sella meningiomas, and the potential benefit of combining approaches to improve surgical outcomes.