Meningiomas are the most prevalent primary intracranial tumor, with 3%–10% arising from the tuberculum sellae. Optimal management consists of total microsurgical resection with preservation of surrounding structures. The authors present a 64-year-old woman with progressive bilateral vision loss, including visual acuity deficits and bitemporal hemianopsia. MRI revealed a 2-cm tuberculum sellae meningioma causing optic apparatus compression. An extended endoscopic endonasal transtuberculum approach was utilized for gross-total resection, including microdissection of tumor from the optic chiasm and infundibulum. Closure was performed with multilayer tensor fascia lata autograft and a pedicled nasal-septal flap. The patient’s postoperative exam showed visual improvement and normal pituitary function.
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