Exoscopic Retrosigmoid Approach for an Anteromedial Tentorial Meningioma: 2D Operative Video.

We present a 2-dimensional operative video (Video 1) of a suboccipital retrosigmoid approach for an anteromedial tentorial meningioma with a specific focus on the use of a surgical exoscope. The patient is a 50-year-old woman who presented to emergency room with a 6-month history of nausea, dizziness, and gait imbalance secondary to a 2.5-cm homogenously enhancing mass originating from the anteromedial tentorium on the right side with associated brainstem compression. Retrosigmoid craniotomy was selected due to the favorable surgical corridor for resection and lower risk of cerebrospinal fluid leak, hearing loss, and seizures compared with other approaches. The patient consented to the procedure. Video 1 emphasizes the advantages of the exoscope compared with the microscope in optimizing surgeon efficiency, ergonomics, and comfort. The unique operating room setup associated with exoscope use is highlighted. The patient underwent uncomplicated gross total resection with a mild trochlear nerve palsy noted postoperatively that was resolved at follow-up..