How I do it: endoscopic endonasal chiasmopexy for optic chiasm prolapse

Background Prolapse of the optic system into an empty sella is an unusual complication of the management of pituitary tumors. Method We described the technical nuances for an endoscopic endonasal chiasmopexy, the indications for the procedure, and the caveats on the diagnosis of optic chiasm prolapse. Conclusion The endoscopic endonasal chiasmopexy provides a direct route to lift the optic system. In most cases, the procedure may be achieved extradurally, protecting the chiasm from manipulation and postoperative fibrosis.