Intraventricular tumours: An individual patient data meta-analysis of conventional craniotomy versus minimally invasive techniques

Intraventricular Tumours (IVTs) are rare intracranial lesions primarily treated with surgery. Surgical modalities include conventional craniotomy and minimally invasive surgery (MIS), such as tubular-assisted and endoscopic surgeries, with unclear benefits associated to each approach.

This systematic review compares gross total resection (GTR) rates, predictors of GTR, post-operative complications and requirement for permanent cerebrospinal fluid (CSF) diversion in conventional and MIS surgery.

Five databases were searched until November 2024, following the PRISMA guidelines. Studies reporting individual-level outcome data for IVT surgery were included.

In total, 361 studies (1500 patients) were included. Most patients underwent conventional craniotomy (n = 1,243, 83%), followed by endoscopic (n = 223, 15%) and tubular-assisted surgery (n = 34, 2.3%). GTR was achieved in 67% (n = 830) of conventional cases compared to 46% (n = 103) of endoscopic and 76% (n = 26) of tubular-assisted approaches (p < 0.001 in univariate analysis; OR 0.38, 95% CrI 0.13-1.13 in multivariable analysis). Complications were reported in 37.8% (n = 567) of patients, among whom 48.9% (n = 277) experienced at least one complication, with most undergoing conventional craniotomy (n = 239). Permanent CSF diversion was required in 65% (n = 277) of patients and was significantly more likely in patients undergoing MIS in univariate analysis. The multivariable analysis revealed that only pre-operative hydrocephalus (OR 8.92, 95% CrI 2.04-38.93) was significantly associated with permanent diversion, while surgical approach was not.

There is a significant unbalance in the amount of cases reported with conventional craniotomy and MIS supporting the early days of MIS approaches for IVTs. Conventional and MIS approaches for IVTs achieve comparable rates of GTR and permanent CSF diversion.