[Intraventricular Tumor Surgery in the Neuroendoscopic Era]

Neuroendoscopic surgery, which allows tumor removal through a narrow surgical corridor, has been increasingly applied to intraventricular tumors. Although this approach is often regarded as minimally invasive, the restricted operative field and proximity to critical deep brain structures necessitate precise surgical manipulation. Periventricular vein injury can result in serious postoperative neurological deficits, underscoring the importance of meticulous dissection and hemostasis. During tumor removal, preservation of venous drainage should be prioritized. Aggressive resection should be avoided when strong adhesion to the veins is encountered. Gentle counterpressure using small cotton patties, combined with irrigation and suction, facilitated safe dissection and effective venous bleeding control. Hemostasis in neuroendoscopic surgery demands patience. The accurate identification of bleeding points is key. Blind coagulation in a blood-filled field should be avoided. Temporary packing with cotton patties can be effective without interrupting surgical workflow. The appropriate use of angled endoscopes and flexible transitions between the dry and wet fields is important for the reliable assessment of residual tumors and hemostasis. Furthermore, careful consideration of surgical instruments and timely conversion to microscopic surgery, when necessary, are critical for minimizing complications. Mastery of these principles can facilitate a safer neuroendoscopic management of intraventricular tumors.