How I do it: endoscopic endonasal transclival resection of ventral foramen magnum meningioma

Background Surgical management of ventral foramen magnum meningiomas (FMMs) is challenging due to intervening neurovascular structures. The endoscopic endonasal transclival approach provides a direct access, offering a potential route to achieve Simpson Grade 1 resection while minimizing brainstem retraction. Method We detail the technical nuances of a binostril, four-handed EEA for a ventral FMM. We explain the key anatomical landmarks required for safe decompression, including clival drilling limits, the identification of pre-medullary neurovascular structures, and the execution of a multilayered reconstruction. Conclusion The EEA is a safe alternative for ventral FMMs in cases without significant lateral or caudal extension.