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Updated: Jul 30, 2025
Author Spotlight: A Single-Entry Point Endoscopic Intraventricular Approach for Third Ventriculostomy and Pineal Biopsy
Published on: June 28, 2024
Endoscopic endonasal approach to remove pediatric intraventricular tumors of the third ventricle
Yuta Tanoue1, Hiroki Morisako2, Tsuyoshi Sasaki2
1Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan. y.tanoue@omu.ac.jp.
Insights
Endoscopic endonasal surgery offers a wider view for treating pediatric third ventricle tumors, enabling aggressive tumor removal while preserving critical brain functions. This minimally invasive approach is effective for tumors extending from the suprasellar region.
Area of Science:
- Neurosurgery
- Pediatric Oncology
- Endoscopic Surgery
Background:
- Pediatric third ventricle tumors are challenging to treat.
- Endonasal endoscopic surgery is increasingly used for skull base lesions.
- Its application in pediatric cases is expanding.
Purpose of the Study:
- To describe a strategy for endonasal endoscopic surgery for pediatric third ventricle tumors.
- To detail surgical anatomies and procedures for these complex cases.
Main Methods:
- Detailed reporting of surgical anatomies and procedures.
- Case presentations illustrating the technique.
- Utilizing a "4-hands technique by two neurosurgeons" for full endoscopic surgery.
Main Results:
- Endoscopic endonasal surgery provides enhanced visualization of the tumor, hypothalamus, and optic chiasm.
- The approach is well-indicated for intra-third ventricular tumors originating from the third ventricle floor.
- Effective for craniopharyngiomas extending into the third ventricle, allowing aggressive removal while preserving visual and memory function.
Conclusions:
- Endonasal endoscopic surgery is a viable strategy for pediatric third ventricle tumors, particularly those with suprasellar extension.
- The described technique facilitates safe and aggressive tumor removal.
- Preservation of neurological function is a key outcome.
Purpose:
Pediatric intraventricular tumors of the third ventricle are among the most difficult-to-treat brain tumors. Recently, endonasal endoscopic surgery for suprasellar, third ventricle, and median clivus lesions has become the common procedure, and its indications are expanding to pediatric cases. We describe our strategy for endonasal endoscopic surgery for pediatric third ventricle tumors.
Method:
We report on surgical anatomies and our surgical procedures in detail, including case presentations.
Result:
Endoscopic endonasal surgery has the advantage of providing a wider view of the tumor site, hypothalamus, optic chiasm, and other critical structures. Good indications for the endoscopic endonasal approach for intra-third ventricular tumors are those arising from the floor of the third ventricle. In particular, craniopharyngioma, a typical pediatric suprasellar tumor, sometimes extends into the third ventricle, causing great operative difficulty. However, aggressive removal for long-term control while preserving memory and visual function is important. We perform surgery with a strategy of radically removing tumors without causing damage to visual or brain function, and we adopt the "4-hands technique by two neurosurgeons" in full endoscopic surgery to remove tumors safely and aggressively.
Conclusion:
We describe our strategy for endonasal endoscopic surgery for pediatric third ventricle tumors, especially those extending from the suprasellar region into the third ventricle, and present a representative case.
