BACKGROUND: The fully endoscopic combined endonasal and supraorbital keyhole approach, which integrates the endoscopic endonasal approach (EEA) and the endoscopic supraorbital keyhole approach (eSKA), is effective for complex suprasellar tumors extending beyond the internal carotid artery (ICA). We detail its application for tuberculum sellae meningiomas with lateral extension. METHOD: Tumor resection is performed via the EEA, with support from the eSKA. This allows for careful management of the optic nerve under direct visualization and enables sufficient tumor resection. CONCLUSION: This combined approach facilitates extensive tumor resection, effective skull base reconstruction, and preservation of surrounding structures.