How I do it: total resection of a giant sphenoclinoidal meningioma with normalization of near blind vision.

Resection of giant sphenoclinoidal meningiomas (SCLM) remains difficult. We discuss a patient presenting with right eye near blindness who underwent total removal of a giant SCLM, resulting in normal vision and no recurrence. Utilizing frontotemporal craniotomy, devascularization, debulking, and detachment was achieved. Microdissection of tumor off the optic nerve and carotid perforators was accomplished, resulting in total resection, visual normalization, and no deficits using efficient face-to-face microscope set-up, 2-surgeon 4-hand technique, and double bipolar-suction arrangement. Frontotemporal craniotomy was adequate. Preservation of the optic nerve and carotid artery is key. Meticulous microsurgical techniques and refined instruments are important for success.