Outcomes and Efficacy of Neuroendoscopic Resection of Intraventricular Tumors: A Systematic Review and Meta-Analysis

Intraventricular neoplasms are predominantly benign tumours and commonly obstruct cerebrospinal fluid flow, causing hydrocephalus and raised intracranial pressure. Purely neuroendoscopic resection has emerged as a minimally invasive alternative to open microsurgery, but reported outcomes vary widely, limiting consensus on its safety and efficacy. We aim to synthesize pooled outcomes in patients undergoing purely neuroendoscopic resection of benign intraventricular tumors through systematic review and meta-analysis. A systematic search was conducted in major databases on May 5, 2025, for studies evaluating neuroendoscopic approaches for intraventricular brain tumor management. Included studies comprised retrospective cohort studies and case series. Statistical analysis was performed using CMA 4.0.0. Heterogeneity was assessed using the I² statistic and the Cochrane Q test. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist. Twenty-seven studies(1054 patients; mean age 36.8 years)were included. Colloid cysts were the most common pathology, with the third ventricle being the most frequent location. Pooled gross total resection rate was 80.5% (95% CI: 0.887 − 0.844, p < 0.001); subtotal resection occurred in 23.9% of cases (95% CI: 0.142–0.374, p < 0.001). The mean operative time was 94.12 minutes (95% CI: 84.74-103.51, and the tumor recurrence rate was 12.3% (95% CI: 0.080–0.233). Postoperative outcomes demonstrated excellent survival rates of 97.0% (95% CI: 0.947–0.983), with hydrocephalus resolution in 94.0% of cases (95% CI: 0.859–0.978). Purely neuroendoscopic resection of benign intraventricular tumors demonstrates favorable outcomes with high gross total resection rates (80.5%), excellent survival rates (97.0%), and effective hydrocephalus resolution (94.0%) with acceptable complication rates. These findings support neuroendoscopy as an effective minimally invasive alternative to traditional microsurgical approaches for appropriately selected intraventricular tumors, particularly colloid cysts. However, careful patient selection and surgeon expertise remain crucial for optimal outcomes.