Case reportIntraventricular mass lesions: Still a question of surgical approach?

- A single center algorithm how to access intraventricular mass lesions is presented.
- The approach to tumors of the lateral ventricles depended on their exact location.
- 3rd ventricle tumors were often cystic and predominately operated endoscopically.
- For fourth ventricular lesions the telovelar approach was used exclusively.

BackgroundIntraventricular mass lesions represent a small subgroup of intracranial neoplasms with various entities. The anatomy of the ventricular system is complex. Hence multiple surgical approaches are used. We sought to present a single center algorithm regarding surgical approach for intraventricular mass lesion.MethodsWe retrospectively reviewed the data of all patients operated in our institution due to a primary intraventricular tumor between 2011 and 2014. Descriptive statistics were used to evaluate clinical presentation, imaging, histology, surgical approach, complications, and clinical outcome.ResultsA total of 52 patients were included in this study comprising 28 (53.8%) female and 24 (46.2%) male patients. The median age was 43.5 years. Lesions location in descending order were fourth ventricle (46.2%), lateral ventricles (28.8%) and third ventricle (25.0%).A telovelar approach was used for all lesions in the fourth ventricle. Cystic lesions of the third ventricle were predominantly operated endoscopically. The surgical approach to the lateral ventricle was transcallosal or transcortical depending on the exact location of the lesion inside the lateral ventricle.We achieved a gross total resection in 82.7% and observed perioperative complications in 19.2% of the patients. Permanent morbidity and mortality were low at 7.7% and 1.9%, respectively.ConclusionThis single center series reveals a predominately used approach for each part of the ventricular system depending on exact location and texture of the mass lesion.