Extreme Lateral Supracerebellar Infratentorial Approach for Resection of Incisural Meningioma: Two-Dimensional Operative Video

Abstract Surgical resection of lesions occupying the incisural space is challenging and requires deep knowledge of the complex neurovascular and skull base anatomy. This video illustrates a case of incisural meningioma that was surgically resected using the extreme lateral supracerebellar infratentorial (SCIT) approach. A 49-year-old woman presented with a history of left-sided numbness, gait instability, and left trochlear nerve palsy. Neuroimaging demonstrated a left incisural meningioma with brainstem compression. Surgical management was indicated using the extreme lateral SCIT. Postoperatively, the patient showed good recovery with residual left trochlear nerve palsy that improved on follow-up. The extreme lateral SCIT approach provided direct access to the incisual space with minimal cerebellar retraction and favorable outcomes.