Management of Anterior Third Ventricular Tumors: A Comprehensive Review and Clinical Experience

Anterior third ventricular tumors, encompassing colloid cysts, gliomas, craniopharyngiomas, and neurocytomas, are rare intracranial neoplasms that present significant diagnostic and therapeutic challenges due to their deep-seated location and proximity to critical neurovascular structures. This chapter synthesizes current literature on their natural history, diagnostic approaches, and management strategies, integrating our clinical experience with 193 cases treated between 1995 and 2023. We explore observation, microsurgical resection, endoscopic surgery, and stereotactic radiosurgery (SRS), providing an in-depth analysis of surgical techniques, their nuances, benefits, and risks. The commonest diagnosis in our series was colloid cyst (72.5%). We achieved a 81.5% complete resection rate with 12% complications overall. Major studies are reviewed to compare outcomes, and a management algorithm is proposed to guide individualized treatment, emphasizing tumor control and quality of life (QOL) preservation. Additionally, emerging molecular and genetic insights into these tumors, pediatric-specific considerations, quality-of-life outcomes, long-term follow-up strategies, and novel surgical or radiological techniques, reflecting the latest evidence-based advancements in the field, are discussed.