Optic pathway hypothalamic gliomas (OPHGs) generally manifest as low-grade tumors, and conventional transcranial approaches remain the primary surgical corridors for tumor resection. Given the intuitive surgical view provided by endoscopic endonasal approaches for hypothalamic lesions, recent advancements have led to ongoing trials for debulking OPHGs. A 30-year-old female patient presented with transient left facial palsy and visual discomfort. Preoperative brain magnetic resonance imaging revealed a heterogeneously enhanced mass measuring approximately 3.3 cm within the third ventricle, accompanied by peritumoral edema in the optic nerve and optic tract. Pathological confirmation was obtained through endoscopy-guided biopsy, subsequently followed by endoscopic endonasal surgery for debulking the tumor mass. As optic pathway gliomas generally have favorable outcomes, postoperative complications significantly contribute to long-term morbidity. The utilization of the endoscopic endonasal approach for OPHGs may successfully alleviate the mass effect on nearby structures with relatively fewer postoperative complications.
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