Microsurgical Resection of a Diaphragma Sellae Meningioma via Extradural Clinoidectomy with Preservation of Superior Hypophyseal Arteries

Diaphragma sellae meningiomas are rare suprasellar tumors often misidentified as tuberculum sellae meningiomas. Their association with the optic nerve, chiasm, pituitary stalk, internal carotid, and superior hypophyseal arteries presents unique surgical challenges. These tumors are classified into three types based on dural attachment with precise subtype identification. We present a Type A diaphragma sella meningioma, located anterior to the pituitary stalk, managed via a pterional craniotomy with extradural anterior clinoidectomy and optic unroofing. Posterior attachment with ICA adhesion and multiple SHA involvement favored a transcranial route, with clinoidectomy and optic unroofing widening the optico-carotid triangle for safe resection.