Surgical outcomes and technical considerations in intraventricular tumors: a retrospective comparative analysis

Intraventricular tumors are a heterogeneous group of neoplasms located within the ventricular system and adjacent eloquent neurovascular structures, making surgical management technically challenging. Multiple surgical corridors, including microsurgical and endoscopic approaches, are available; however, the relative impact of surgical approach versus extent of resection and preoperative functional status on outcomes remains incompletely defined. We conducted a retrospective, single-center observational study of patients who underwent surgical management for intraventricular tumors between 2015 and 2024. Demographic, clinical, radiological, surgical, and pathological data were collected. Surgical approaches were categorized as transcortical, transcallosal, endoscopic excision, interhemispheric, or other approaches. Primary outcomes included extent of resection, postoperative functional outcome measured by the modified Rankin Scale, postoperative complications, and tumor recurrence. Multivariable logistic regression and Kaplan–Meier analyses were performed to identify predictors of recurrence and complications. A total of 861 patients were included, with a median age of 36 years and a male predominance (71.3%). Gross total resection was achieved in 81.6% of cases. Postoperative complications occurred in 24.4% of patients, and tumor recurrence was observed in 4.8% during a median follow-up of 10 months. No surgical approach was independently associated with recurrence or postoperative complications. In contrast, higher preoperative mRS scores were independently associated with increased risk of both recurrence (OR 1.82, p < 0.001) and postoperative complications (OR 2.08, p = 0.03). Extent of resection significantly influenced recurrence-free survival, with total resection demonstrating superior long-term tumor control. In the surgical management of intraventricular tumors, long-term outcomes are primarily driven by extent of resection and preoperative functional status rather than the choice of surgical approach. While endoscopic and minimally invasive techniques are safe and effective in selected cases, they do not independently improve oncologic outcomes when incomplete resection is achieved. Surgical strategy should therefore prioritize maximal safe resection and early intervention, with approach selection tailored to tumor anatomy and patient-specific factors.