Surgery for clinoidal meningiomas with cavernous sinus extension: Near-total excision and chiasmopexy

BACKGROUND: The main factors limiting the extent of resection for clinoidal meningiomas are cavernous sinus extension and vessel adventitia involvement. The proximity to the optic apparatus and the risk of radiation-induced optic neuropathy often prevents many surgeons from proposing adjuvant radiosurgery. METHOD: We describe a simple technical solution that is to place a fat graft between the optic apparatus and the residual tumor to maintain the distance gained at surgery and facilitates the identification of anatomic structures. CONCLUSION: This technique allows to deliver optimal therapeutic doses to the residue reduces the dose received by the optic nerve below 8 Gy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-022-05281-z.