Comparative assessment of endoscopic and microsurgery resection for intracranial ventricular tumors: a meta-analysis of 3059 patients.

Abstract

Background and aim: Surgical resection of ventricular brain tumors is traditionally performed via microsurgery, which requires open craniotomy and can result in significant complications. Endoscopic approaches have emerged as minimally invasive alternatives. There is a lack of consensus regarding the preferred surgical strategy for ventricular tumor resection; the technique with the optimal rates of recurrence, mortality, and complications is debatable.

Objectives: This article aims to evaluate the efficacy of endoscopic resection in comparison to microsurgical resection, focusing on identifying the approach with superior clinical outcomes.

Method: To determine surgical outcomes, we performed a meta-analysis of the existing original studies across PubMed, SCOPUS, Cochrane, and Web of Science medical databases from inception to 20 February 2024, per PRISMA guidelines that discussed microsurgery and endoscopic resection in ventricular tumors. Eligible studies (n = 47) were included, which contained data describing clinical outcomes, postoperative complications, and mortality rates that were extracted and analyzed.

Results: A total of 47 studies, encompassing 3,059 patients (1,121 microsurgery, 1,938 endoscopy), were included. The mean age was 37.4 years (range 6-64), with 66.62% male (1,701/3,059). Colloid cysts were present in 67% (1,629/3,059), predominantly located in the third ventricle (55%, 715/1,301). Headache (96.15%, 2,700/2,808) was the most common symptom, followed by nausea/vomiting (12.5%, 351/2,808) and visual field deficits (11.26%, 316/2,808). The pooled gross-total resection (GTR) rate was 81.5% (95% CI, 75-88.1%; I²=66.66%), with endoscopic and microsurgery subgroups yielding GTR rates of 80% and 84.4%, respectively. Recurrence occurred in 4.7% (95% CI, 2.8-6.6%; I²=72.74%), with endoscopic and microsurgery rates of 3.9% and 6.6%. The mortality rate was 1.7% (95% CI, 0.9-2.5%; I²=29.1%), lower in endoscopic (0.6%) than microsurgery (5.2%). Postoperative hydrocephalus was noted in 4.8% (95% CI, 1.5-8.1%; I²=49.7%), cognitive deficits in 4.9% (95% CI, 3-6.9%; I²=33.57%), and cerebrospinal fluid leakage in 4.7% (95% CI, 1.8-7.6%; I²=53.81%). Seizures occurred in 3.6% (95% CI, 2-5.2%; I²=5.08%), neurological deficits in 5.5% (95% CI, 3-8%; I²=72.64%), visual field defects in 4.3% (95% CI, 2.6-6%; I²=35%), and wound infections in 2.5% (95% CI, 1-4%; I²=0%). Subgroup analyses generally showed lower complication rates for endoscopic surgery compared to microsurgery.

Conclusion: Endoscopic resection offers favorable trends in the management of ventricular tumors. These include improved neurological outcomes, postoperative complications such as visual field defects and seizure rates, and lower mortality rates. Despite the need for further research to fully elucidate its benefits, Endoscopic resection stands out as a valuable technique in advancing neurosurgical care for ventricular tumor patients.