Endoscopic endonasal approach with extended orbital roof removal for a giant esthesioneuroblastoma: illustrative case.

backgroundEsthesioneuroblastoma (ENB) is a rare malignant tumor originating from the olfactory epithelium, often involving the anterior skull base with intracranial extension. Surgical management options include the transcranial approach combined with the endoscopic endonasal approach (EEA) or purely EEA. However, conventional indications for EEA are limited to tumors with lateral extension not exceeding the midorbital line, due to restricted lateral exposure. Logically, extending the resection of the orbital roof bone can enhance lateral access, potentially expanding the surgical indications for EEA in selected cases. OBSERVATIONS: A young male patient presented with epistaxis and was diagnosed with a giant ENB involving the nasal cavity and anterior skull base. Through an EEA, extended resection of the orbital roof was performed to achieve gross-total tumor removal. The patient recovered uneventfully, with no neurological deficits, and follow-up at 6 months showed no evidence of tumor recurrence. LESSONS: The EEA offers inherent advantages, such as avoiding brain retraction and minimizing invasiveness. With improved understanding of skull base anatomy, the indications for EEA can be expanded beyond traditional limits, including tumors extending lateral to the midorbital line. In appropriate cases, this approach may obviate the need for craniotomy, reducing surgical morbidity. https://thejns.org/doi/10.3171/CASE25914.