Contralateral orbitopterional approach for anterior skull base meningioma resection

The authors present the resection of an anterior skull base parasellar meningioma causing vasogenic edema due to compression of the frontopolar vein. A contralateral orbitopterional craniotomy was chosen to provide a minimally invasive approach while avoiding morbidity from a bifrontal approach. Extradural removal of the orbital roof minimized frontal lobe retraction. The infrafrontal corridor enabled identification and preservation of the olfactory and optic nerves, the carotid artery, and the frontopolar vein. Circumferential microsurgical dissection with low-power bipolar coagulation enabled en bloc tumor removal. Postoperative MRI confirmed gross-total resection, resolution of the edema, and preservation of the vein. The patient had an uneventful recovery and intact neurological function at the 5-week follow-up. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25189