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The talk is about a surgical procedure aimed at addressing obstructive hydrocephalus caused by a fourth ventricular mass. Dr. Kunal Vakharia, a neurosurgeon based in Florida, presents a case involving a 67-year-old patient experiencing gait issues, balance difficulties, and occipital headaches. Through axial and sagittal T1 contrast MRI, as well as T2 imaging, the presence of hydrocephalus and a heterogeneous mass within the fourth ventricle is identified. Surgical intervention is discussed considering the patient's symptoms and concerns. The procedure involves suboccipital craniotomy and durotomy with careful navigation and microscope use. Techniques such as dynamic retraction, bipolar coagulation, and meticulous dissection aid in tumor removal, ensuring preservation of surrounding structures. Post-operatively, imaging confirms gross total resection, with the patient demonstrating positive outcomes. This presentation highlights the surgical intricacies involved in addressing rare tumors like fourth ventricular meningiomas, emphasizing technique and patient-centered care.