E-ISSN: 1019-5157
ISSN: 2651-5024
Technical Note
Exoscopic Occipital Transtentorial Approach for a Falcotentorial Meningioma Using ORBEYE™: A Technical Case Report
Toshihihro Ogiwara✉ ,
Atsushi Sato ,
Mana Wakabayashi ,
Kazuhiro Hongo ,
Yasuhiko Hayashi
Neurosurgery, Kanazawa Medical University; Pituitary and Neuroendoscopy Center, Ina Central Hospital
Accepted: 14/08/2026
Article in Press
Corresponding Author:
Toshihihro Ogiwara (togiwara@kanazawa-med.ac.jp)
Abstract
Background/Study Aims: Pineal tumors are rare and pose significant surgical challenges owing to their deep location and proximity to critical neurovascular structures. The occipital transtentorial approach (OTA) is a well-established route for resecting these lesions. However, conventional OTA with an operating microscope has inherent limitations, including narrow operative corridors, constrained depth perception, and the requirement for occipital lobe retraction, which may contribute to postoperative morbidity. Recent advances in digital visualization, particularly three-dimensional (3D) 4K exoscopes, have offered enhanced magnification, improved ergonomics, and greater surgical maneuverability. This report illustrates the use of a 3D4K exoscope (ORBEYE™, Olympus, Tokyo, Japan) during OTA for a falcotentorial meningioma and evaluates its practical advantages compared to conventional microscopic and endoscopic techniques.
Clinical Presentation: A 51-year-old man presented with persistent headache. Magnetic resonance imaging revealed a calcified, homogeneously enhancing extra-axial mass in the pineal region, consistent with a falcotentorial meningioma. Due to the tumor’s firm consistency and steep tentorial angle, OTA was selected and performed with the assistance of the ORBEYE™ 3D4K exoscope. This approach facilitated accurate anatomical dissection and panoramic visualization, improving surgeon ergonomics. Gross total resection was achieved without neurological deficits or perioperative complications.
Conclusion: Exoscopic OTA combines the precision of microscopic techniques with the wide-angle visualization of endoscopy, enhancing surgical safety, operator comfort, and resection efficiency in pineal surgery. This case highlights the clinical utility of exoscopes and supports their integration as a viable standard for deep midline neurosurgical procedures.
Clinical Presentation: A 51-year-old man presented with persistent headache. Magnetic resonance imaging revealed a calcified, homogeneously enhancing extra-axial mass in the pineal region, consistent with a falcotentorial meningioma. Due to the tumor’s firm consistency and steep tentorial angle, OTA was selected and performed with the assistance of the ORBEYE™ 3D4K exoscope. This approach facilitated accurate anatomical dissection and panoramic visualization, improving surgeon ergonomics. Gross total resection was achieved without neurological deficits or perioperative complications.
Conclusion: Exoscopic OTA combines the precision of microscopic techniques with the wide-angle visualization of endoscopy, enhancing surgical safety, operator comfort, and resection efficiency in pineal surgery. This case highlights the clinical utility of exoscopes and supports their integration as a viable standard for deep midline neurosurgical procedures.
Keywords
3D4K exoscope
minimally invasive neurosurgery
occipital transtentorial approach
ORBEYE
pineal region tumor