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One of the most common approaches for AFM meningiomas is the far lateral approach. We describe our exo- and endoscopic two-step approach (EETA) through suboccipital craniotomy. An exoscope is used to remove the tumour\u2019s lateral part, whereas an endoscope is used to remove the residual tumour in the exoscope\u2019s blind spots, including the brainstem\u2019s ventral side. EETA is a viable option for treating AFM meningiomas because it provides an adequate surgical field of view and is minimally invasive.<\/jats:p>","DOI":"10.1007\/s00701-025-06512-9","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T08:56:24Z","timestamp":1744620984000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Exo- and endoscopic two-step approach for anterior foramen magnum meningiomas: How I do it"],"prefix":"10.1007","volume":"167","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3962-9573","authenticated-orcid":false,"given":"Kenichiro","family":"Iwami","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4130-5380","authenticated-orcid":false,"given":"Yuichi","family":"Nagata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0185-3278","authenticated-orcid":false,"given":"Tadashi","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2484-1360","authenticated-orcid":false,"given":"Ryuta","family":"Saito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"6512_CR1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s10143-007-0097-1","volume":"31","author":"M Bruneau","year":"2008","unstructured":"Bruneau M, George B (2008) Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisiere Hospital and review of the literature. Neurosurg Rev 31:19\u201332. https:\/\/doi.org\/10.1007\/s10143-007-0097-1. discussion 32-3","journal-title":"Neurosurg Rev"},{"key":"6512_CR2","doi-asserted-by":"publisher","first-page":"E12","DOI":"10.3171\/2013.10.FOCUS13332","volume":"35","author":"BC Flores","year":"2013","unstructured":"Flores BC, Boudreaux BP, Klinger DR, Mickey BE, Barnett SL (2013) The far-lateral approach for foramen magnum meningiomas. Neurosurg Focus 35:E12. https:\/\/doi.org\/10.3171\/2013.10.FOCUS13332","journal-title":"Neurosurg Focus"},{"key":"6512_CR3","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1007\/s00701-024-06091-1","volume":"166","author":"DA Gattozzi","year":"2024","unstructured":"Gattozzi DA, Erginoglu U, Khanna O, Hosokawa PW, Martinez-Perez R, Baskaya MK, Youssef AS (2024) Novel classification of foramen magnum meningiomas predicted by topographic position relative to neurovascular bundle. 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Curr Oncol 28:3945\u20133958. https:\/\/doi.org\/10.3390\/curroncol28050336","journal-title":"Curr Oncol"},{"key":"6512_CR7","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1007\/s00701-024-06298-2","volume":"166","author":"K Iwami","year":"2024","unstructured":"Iwami K, Watanabe T, Takeuchi K, Saito R (2024) Exo- and endoscopic two-step approach for meningeal tumours invading the lateral wall of large dural venous sinuses: how I do it. Acta Neurochir (Wien) 166:397. https:\/\/doi.org\/10.1007\/s00701-024-06298-2","journal-title":"Acta Neurochir (Wien)"},{"key":"6512_CR6","doi-asserted-by":"publisher","first-page":"e1220","DOI":"10.1016\/j.wneu.2023.04.102","volume":"175","author":"AJ Schupper","year":"2023","unstructured":"Schupper AJ, Hrabarchuk EI, McCarthy L, Hadjipanayis CG (2023) Improving surgeon well-being: ergonomics in neurosurgery. World Neurosurg 175:e1220\u2013e1225. https:\/\/doi.org\/10.1016\/j.wneu.2023.04.102","journal-title":"World Neurosurg"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06512-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-025-06512-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06512-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T08:56:25Z","timestamp":1744620985000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-025-06512-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6512"],"URL":"https:\/\/doi.org\/10.1007\/s00701-025-06512-9","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]},"assertion":[{"value":"28 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of Aichi Medical University Hospital (approval number: 2020\u2013020) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from all patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"104"}}