Purely Endoscopic Resection of a Tectal Plate Pilocytic Astrocytoma through a Supracerebellar Infratentorial Approach – A Two-Dimensional Operative Video

Tectal plate gliomas are rare, indolent lesions that present unique surgical challenges. They are approached via the occipital transtentorial or supracerebellar infratentorial corridors. We describe a 38-year-old male with a tectal plate pilocytic astrocytoma with progressive increase in the size of the lesion. While the endoscope has been used to improve visualisation and check completeness of resection, we present a video of a pure endoscopic Krause approach, discussing the operative steps, and the advantages of using the endoscope. A purely endoscopic supracerebellar infratentorial approach was performed via a small suboccipital craniotomy in sitting position using both 0-degree and 30-degree endoscopes, excising the lesion. In this case, the purely endoscopic supracerebellar infratentorial approach was a useful adjunct, enhancing illumination and visualisation.