Endoscopic Management of Pediatric Third Ventricular Tumors with Hydrocephalus: A Single-Centre Experience

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Third ventricular tumors have varied histopathology and natural history. They commonly present in childhood with hydrocephalus. This study aims to assess the effectiveness of endoscopic biopsy and endoscopic third ventriculostomy (ETV) in the diagnosis and management of pediatric third ventricular tumors with hydrocephalus. Clinical and radiological data of 30 consecutive children, who underwent endoscopic procedures for third ventricular tumors with hydrocephalus between January 2015 and May 2023 were retrospectively analyzed. Mean age was 9.7 ± 5.4 years with 20 (66.7%) males. All children had raised intracranial pressure. Twelve (40%) underwent ETV with endoscopic biopsy, 14 (46.7%) underwent endoscopic biopsy and ventriculoperitoneal shunt (VPS), and four (13.3%) ETV alone. Sixteen patients underwent ETV: 15 (93.8%) were successful and one (6.3%) required VPS. Four patients underwent ETV alone, and diagnosis was obtained by stereotactic biopsy (STB) in three and craniotomy in one. Twenty-six children underwent endoscopic biopsy, and a diagnosis was obtained in 24 (92.3%). The pathologies (n = 28) were low-grade glioma (8), high-grade glioma (6), pineal tumors (6), germ cell tumors(3), lymphoma (2), and others (3). Two patients with low-grade gliomas underwent craniotomy and excision. Twenty-one patients received adjuvant therapy. Three patients were lost to follow-up. Among the remaining 27 patients (follow-up range 1–96 months, mean 24.6 months, median 15 months), 20 were stable or improved, four had poor outcomes, and three died within 3 months of intervention. Endoscopic procedures are an effective, less invasive option to manage pediatric third ventricular tumors, with high ETV success and diagnostic yield.