Purely Endoscopic Removal of Intraventricular Brain Tumors: A Consensus Opinion and Update

Background: The main purpose of this project is to define the major indications, preferences, techniques, limitations, and complications associated with intraventricular tumor removal using purely endoscopic techniques. Methods: Published papers on neuroendoscopy were reviewed, and a questionnaire about purely endoscopic surgery for intraventricular brain tumors was designed. The questionnaire included details regarding neuroendoscopic techniques, surgeons' endoscopic experience, and clinical vignettes. 20 experienced neuroendoscopists from the 10 represented countries were surveyed. Results: 15 physicians (75%) responded to the survey, having an estimated 264 cumulative years of endoscopic experience. There was general agreement regarding: the instrumentation used, endoscope features, irrigation, technique of colloid cyst and solid intraventricular tumor removal, complications, future technologies, and the treatment of sample clinical vignettes. There was appreciable variability in endoscope control preferences. Conclusions: Endoscopic intraventricular surgery is a feasible minimally invasive alternative to open transcranial surgery for specific ventricular tumors. With the currently available instrumentation, the technique can be applied to small avascular solid intraventriclular tumors and colloid cysts of the third ventricle. The majority of the complications are based on hemostasis potential. The development of compatible instrumentation with an enhanced ability for solid tumor removal and more adequate hemostasis appear to be the principle limitations in furthering the technique of endoscopic removal of intraventricular brain tumors.