Neuroendoscopic Transventricular Approach for Prepontine Biopsy in a Child: A Minimally Invasive Route to Skull Base Pathology. Technical Note

Abstract We present the case of an 8-year-old female patient with a large skull base lesion presenting clinically with signs of increased intracranial pressure and obstructive hydrocephalus. Due to the lesion’s location and associated hydrocephalus, a minimally invasive neuronavigated intraventricular biopsy was performed via the prepontine cistern. Institutional review board approval was obtained. Legal guardians provided consent for the procedure and use of the patient's image. The operating surgeon also consented to the use of their image in the video. This approach allowed for safe tissue sampling while simultaneously addressing cerebrospinal fluid circulation impairment through endoscopic third ventriculostomy. The case highlights the feasibility and efficacy of combining intraventricular neuroendoscopy with neuronavigation for managing complex skull base lesions in pediatric patients. Minimally invasive intraventricular biopsy techniques guided by neuronavigation have been reported in the literature as valuable tools for obtaining diagnostic tissue in challenging anatomical locations while minimizing morbidity. Moreover, endoscopic third ventriculostomy remains a standard intervention for obstructive hydrocephalus, especially when performed concomitantly with lesion biopsy to optimize patient outcomes. Our report adds to this growing body of evidence by demonstrating successful application in a pediatric skull base tumor with significant mass effect. This case underscores the importance of a tailored, multidisciplinary approach combining advanced neuroendoscopic techniques and neuronavigation to improve diagnostic accuracy and therapeutic safety in complex neurosurgical cases.