Exoscopic resection of tentorial meningiomas: Technical note from the exoscope era

Background: Tentorial meningioma resection is among the most challenging neurosurgical procedures. Various surgical approaches must be considered, including subtemporal, lateral suboccipital, occipital interhemispheric supratentorial, and supracerebellar transtentorial (SCTT) techniques. However, performing tentorial meningioma resections in the SCTT approach using operative microscopy often requires awkward positioning for the neurosurgeon. In this study, we report two cases of tentorial meningioma resection and discuss the utility and limitations of the 4KHD 3D operating room layout, showing the use of the exoscope (ORBEYE) system for this procedure. Methods: At our institution, we use the ORBEYE system (Olympus, Tokyo, Japan) for resecting tentorial meningioma. Peri-embolization and perioperative clinical and surgical data were retrospectively analyzed. Results: Our preferred exoscope system not only enhances visualization during neurosurgical procedures but also improves surgeon ergonomics during surgery. Conclusion: Exoscopic surgery using ORBEYE may help simplify complex neurosurgical procedures, including the resection of surgically challenging lesions such as tentorial meningiomas, although limitations remain in the management of large tumors.