# From the Infratentorial to the Supratentorial Compartment with a Minimally Invasive Exoscope-Guided Suboccipital Craniectomy: A Case Report and Technical Notes

## TL;DR

This case report describes a minimally invasive brain surgery using an exoscope to remove a large meningioma, highlighting improved visualization and team coordination.

## Contribution

The paper presents a novel application of exoscope technology in a prone suboccipital approach for meningioma resection.

## Key findings

- The exoscope's long working distance and co-axial illumination enabled efficient tumor dissection with fewer repositioning events.
- Shared display improved team coordination during critical steps like hemostasis and capsule mobilization.
- The 18-month MRI showed no tumor recurrence, indicating a successful outcome.

## Abstract

Background: Surgical exoscopes represent a significant advancement in neurosurgical procedures, offering enhanced visualization through 3D high-definition digital imaging and superior ergonomics. While their adoption is increasing, the full scope of applications and advantages evident in posterior fossa prone suboccipital approaches remains limited. Case Description: We present a detailed technical report of a minimally invasive exoscope-guided suboccipital approach for the resection of a large tentorial meningioma extending into both supra- and infratentorial compartments. Results: The exoscope’s long working distance and co-axial illumination supported circumferential dissection of the tumor–arachnoid interface with reduced instrument–optics conflict and fewer scope repositioning events. Team visualization via shared display improved coordination during hemostasis and capsule mobilization. The early outcome was favorable; the 18-month MRI (added) showed no residual or recurrence. Conclusions: In a prone suboccipital approach, the exoscope enabled stable depth cues in a deep, narrow corridor, minimized optics interference, and enhanced team coordination. These case-specific findings clarify how exoscope features can translate to operative efficiency in posterior fossa surgery while underscoring the need for prospective, comparative, and cost-effectiveness studies.