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This episode showcases a surgical procedure on a 32-year-old patient with headaches, revealing a fourth ventricular ependymoma. The surgery involves a suboccipital craniotomy to expose the tumor, followed by dissection of arachnoid planes and identification of critical structures such as lower cranial nerves and arteries. The use of various dissectors, suction, gel foam, and electrocautery aids in managing vascularity and achieving hemostasis. The surgeon employs an ultrasonic aspirator to safely debulk the tumor, preserving vascular structures. It created a surgical corridor between the two cerebellar hemispheres for visualization up to the aqueduct, ensuring thorough removal of the tumor. Post-surgery MRI confirms the absence of gross residual tumor and depicts the surgical corridor. The procedure aims to alleviate the patient's headaches by addressing potential obstruction and demonstrates an approach to ependymoma resection with a focus on preserving critical structures.