Outcomes and efficacy of neuroendoscopic resection of intraventricular tumors: A systematic review and meta-analysis.

Abstract

e14107 Background: Intraventricular neoplasms predominantly comprise benign tumors that obstruct cerebrospinal fluid flow, causing hydrocephalus and intracranial hypertension. While open microsurgical approaches have historically served as the standard treatment, neuroendoscopy has emerged as a minimally invasive alternative with potential advantages. However, reported surgical outcomes remain inconsistent, limiting consensus regarding the safety and efficacy of purely neuroendoscopic tumor resection. Methods: A comprehensive systematic review was conducted following PRISMA guidelines. Electronic databases were searched on May 5, 2025, for studies evaluating neuroendoscopic approaches for intraventricular tumor management. Included studies comprised retrospective cohort studies and case series involving adults (≥18 years) with histologically confirmed benign intraventricular brain tumors undergoing purely neuroendoscopic tumor resection. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis was conducted using random-effects models with appropriate effect measures. Results: Twenty-eight studies encompassing 1,054 patients were included in the meta-analysis. The mean patient age was 36.8 years (range 18-80), with 42% male and 36.8% female participants. Colloid cysts comprised 74% of tumors, followed by craniopharyngiomas (10%) and astrocytomas (3.57%). The pooled gross total resection rate was 80.5% (95% CI: 0.887-0.844, p<0.001), while subtotal resection occurred in 23.9% of cases (95% CI: 0.142-0.374, p<0.001). Mean operative time was 94.12 minutes (95% CI: 84.74-103.51). Intraoperative hemorrhage occurred in 11.0% of patients (95% CI: 0.048-0.242), and the tumor recurrence rate was 12.3% (95% CI: 0.080-0.233). Postoperative outcomes demonstrated excellent survival rates of 97.0% (95% CI: 0.947-0.983), with hydrocephalus resolution in 94.0% of cases (95% CI: 0.859-0.978). New neurological deficits occurred in 12.5% of patients (95% CI: 0.081-0.190), postoperative infections in 8.5% (95% CI: 0.044-0.098), and permanent shunt requirement in 5.9% (95% CI: 0.038-0.098). Conclusions: Neuroendoscopic resection of intraventricular tumors demonstrates favorable outcomes with high gross total resection rates, excellent survival rates, and effective hydrocephalus resolution. The procedure is associated with acceptable complication rates, including low permanent shunt dependency and moderate rates of new neurological deficits. These findings support neuroendoscopy as an effective minimally invasive alternative to traditional microsurgical approaches for appropriately selected intraventricular tumors, particularly colloid cysts and other centrally located lesions. However, careful patient selection and surgeon expertise remain crucial for optimal outcomes.