BACKGROUND: Deep-seated brain tumors pose a distinctive neurosurgical challenge, as frequently surrounded by eloquent structures. 3D exoscope represents a potential new paradigm for mini-invasive neurosurgery, which shows advantage during the neurosurgical procedure for this kind of challenging cases. METHODS: Utilizing a combination of 3D exoscopes and endoscopes, we successfully removed a left tentorial meningioma in a patient via a subtemporal keyhole approach. CONCLUSION: Combination of 3D exoscope and endoscope has the advantages of precise tissue identification, minimized brain traction and enhanced visibility in hidden areas by integrating the strengths of both.