We present a 2-D operative video of a suboccipital retrosigmoid approach for an antero-medial tentorial meningioma with a specific focus on the use of a surgical exoscope. The patient is a 50-year-old female who presented to emergency room with 6 months of nausea, dizziness, and gait imbalance secondary to a 2.5cm homogenously enhancing mass originating from the anteromedial tentorium on the right side with associated brainstem compression. Retrosigmoid craniotomy was selected due to the favorable surgical corridor for resection and lower risk of cerebrospinal fluid leak, hearing loss, and seizures compared to other approaches.1-5 The patient consented to the procedure. The operative video emphasizes the advantages of the exoscope compared to the microscope in optimizing surgeon efficiency, ergonomics, and comfort.6 The unique operating room set-up associated with exoscope use is highlighted. The patient underwent an uncomplicated gross total resection with a mild trochlear nerve palsy noted post-operatively that was resolved at follow-up.7.