Ventriculoscopic Management of Lesions in The Vicinity of the Third Ventricle | ||
| The Egyptian Journal of Hospital Medicine | ||
| Volume 100, Issue 1, July 2025, Pages 4415-4420 PDF (433.85 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejhm.2025.454571 | ||
| Abstract | ||
| Background: Lesions of the third ventricle remain surgically challenging because traditional microsurgical approaches, such as the transcortical or transcallosal routes, are associated with significant morbidity. The development of neuroendoscopic techniques has provided a minimally invasive alternative that permits lesion management and simultaneous cerebrospinal fluid (CSF) diversion. Objective: To evaluate the safety, efficacy, and short-term outcomes of ventriculoscopic management for lesions located in or adjacent to the third ventricle. Patients and Methods: A prospective single-center clinical trial was conducted at Tanta University Hospitals including 20 patients older than six months with MRI-defined third-ventricular lesions. All patients underwent ventriculoscopic procedures tailored to lesion type, with or without endoscopic third ventriculostomy (ETV). Clinical and radiological parameters—including headache severity (VAS), papilledema grade, Evans index, and complication profile—were assessed at baseline and at 1, 3, and 6 months postoperatively. Results: The mean preoperative headache score improved significantly from 7.1±1.5 to 0.5±1.0 postoperatively (p<0.001). Papilledema resolved or improved in 100% of cases, with complete resolution in 85%. The Evans index decreased from 0.44±0.08 to 0.24±0.07 (p<0.001). Overall clinical outcome was excellent in 15 patients (75%), good in 3 (15%), and fair in 2 (10%). Complications included transient fever (45%), transient memory loss (15%), intraventricular hemorrhage (10%), subgaleal collection (20%), and VP shunt requirement (25%). Favorable outcomes correlated with lower postoperative Evans index, papilledema resolution, and absence of gait disturbance. Conclusions: Ventriculoscopy is a safe and effective minimally invasive approach for third-ventricular lesions. It achieves substantial symptom relief, radiological improvement, and high rates of excellent clinical outcomes, with an acceptable complication profile. Larger multicenter studies are warranted to validate prognostic factors such as Evans index reduction and papilledema improvement. | ||
| Keywords | ||
| Cranial endoscopy; Third ventricular lesions; Ventriculoscopy | ||
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