[Surgical Strategies for Suprasellar Meningiomas in the Endoscopic Era]

Surgical management of suprasellar meningiomas is challenging because of their proximity to critical neurovascular structures, including the optic apparatus and internal carotid artery. Ttreatment aims to preserve visual and neurological functions, while achieving durable tumor control. This review classified suprasellar meningiomas into medial and lateral types to clarify surgical strategies. Medial-type tumors, including tuberculum sellae, planum sphenoidale, and olfactory groove meningiomas, often compress the optic nerves inferiorly and may be suitable for endoscopic endonasal approaches in select cases. Contrastingly, lateral-type tumors, such as sphenoid wing and anterior clinoid meningiomas, frequently involve the internal carotid artery and cavernous sinus, and are best managed through transcranial approaches. Keyhole surgery may be considered in select cases to reduce surgical invasiveness. Endoscopic endonasal surgery for lateral-type tumors is generally not indicated, except in combined approaches for selective decompression of medial components. Optimal management requires an individualized approach based on tumor location, extension, and neurovascular involvement, prioritizing functional preservation over radical resection.