Minimally invasive resection of solid intraventricular lesions via single burr-hole ventriculoscopy

Maximal safe resection of intraventricular lesions remains challenging. This study evaluated the feasibility, technical workflow, and clinical outcomes of single burr-hole pure ventriculoscopic resection for small solid intraventricular lesions.

We retrospectively reviewed patients who underwent single burr-hole pure ventriculoscopic resection of solid intraventricular lesions. Clinical, radiological, operative, and postoperative data were collected. All patients received high-resolution 3D-SPACE MRI, and virtual ventriculoscopic reconstruction using 3D Slicer software for individualized trajectory planning. Lesions were resected using a 6-mm rigid ventriculoscope. Postoperative MRI was performed to evaluate the extent of resection, and patients were followed for neurological outcomes and complications.

Thirty-eight patients (median lesion diameter: 17 mm) underwent surgery. Gross-total resection was achieved in 92.1% (35/38) of cases. No seizures, cerebrospinal fluid leakage, permanent neurological deficits, or mortality occurred. Complications included transient diplopia in 2 patients (5.3%) and one intracranial infection (2.6%). Pathological diagnoses included cavernous malformations in 14 patients, subependymomas in 10, meningiomas in 8, low-grade gliomas in 3, and neurofibroma, pseudoaneurysm, and inflammatory granuloma in 1 patient each. During a mean follow-up of 60 months, no definite lesion recurrence was observed, and one patient developed delayed hydrocephalus that was successfully treated endoscopically. The planned surgical trajectories showed good concordance with intraoperative findings, supporting the accuracy of preoperative virtual planning.

Single burr-hole pure ventriculoscopic resection is a safe and feasible minimally invasive approach for selected small intraventricular lesions, enabling high rates of complete resection with low morbidity and favorable long-term outcomes.