| Abstract: |
Tumors arising within the ventricular compartment or extrinsically in periventricular regions with the mass extending into the ventricles can originate from a variety of cell types. However, they all retain a few key unifying features including a tendency to manifest clinically with obstructive hydrocephalus, a capacity for voluminous sizes, and, in several cases, a potential for complications with resection including difficulty achieving hemostasis and consequent postoperative hydrocephalus. In pediatric patients, most ventricular and periventricular tumors tend to be developmentally derived, and most are benign or low grade. Thus in some cases, it may be possible to sample the tumor, divert cerebrospinal fluid, and schedule close follow-up and imaging to monitor progression. When a tumor has a higher likelihood of progressing, is high grade, is symptomatic, or is curable with resection, surgical resection is favored, typically with a goal of gross total resection, given the significant side effects of radiation that should be avoided in the developing brain when possible. Surgical approaches vary based on tumor location, categorized generally into three regions for supratentorial ventricular, and periventricular tumors, as follows: (1) lateral ventricles, (2) anterior third ventricle, and (3) posterior third ventricle/pineal region/rostral mesencephalon. While the majority of traditional open surgical approaches to the lateral and posterior third ventricles have remained constant, intraventricular endoscopy has introduced a new era of minimally invasive, effective, morbidity-reducing approaches to pathology of the anterior third ventricle. Additionally, tubular surgery has allowed less invasive access to some tumors of the lateral ventricles. Increasing information about tumor biology has also opened up the possibility for targeted molecular therapies, particularly useful in tumor recurrence or for suboptimal surgical candidates. © 2023 Elsevier Inc. All rights reserved. |
