How I do it: minimally invasive resection of a sub-ependymoma of the fourth ventricle

BACKGROUND: A 54-year-old female was referred to our clinic with a lesion of the lower fourth ventricle extending to the median aperture. Here, we report the use a minimally invasive sub-occipital approach (MISA) as a safe and effective surgical management. METHOD: We performed a MISA using a short midline incision and a 1-cm sub-occipital craniectomy. Dissection of the lesion was performed, and “en bloc” resection could be achieved. The lesion was confirmed to be a grade I sub-ependymoma. CONCLUSION: MISA can be safely used when confronted to a lesion of the lower fourth ventricle. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-020-04601-5) contains supplementary material, which is available to authorized users.