No mortality or morbidity due to the procedures was present. Mild or severe bleeding was successfully controlled with the Tm Laser. Following ETV failure in six cases, a one-catheter VP shunt was implanted. In two patients with entrapped ventricle the fenestration was redone, while two cystic tumors were treated microsurgically.

The reconstruction of CSF pathways increased the median KPS > 80 (range 60–100). The follow-up ranged from 1 to 10 years, with periodic clinical and MRI examinations. In 4 tectal low-grade astrocytomas ETV was definitely the only surgical treatment. After intracranial hypertension control was achieved, in 13 malignant gliomas, 5 leptomeningeal metastases, and other malignant tumors, specific chemotherapy and/or radiotherapy was administered, improving quality of life and overall survival. Patients with tumors responding to therapy or radionecrosis showed a longer overall survival.

Ventricular tumors represent a heterogeneous group in terms of histology and therapy, but they often present a common clinical history and common radiological aspects [14, 19]. The most frequent type of clinical presentation is a syndrome arising from intracranial hypertension. In the present series this syndrome was present in 30 % of our patients, accompanied by ventricle dilation due to blockage of the CSF pathways with hydrocephalus or entrapped ventricle. In these cases the patients’ clinical features ruled out the possibility of performing other therapies as an alternative to surgery, which is elective both for diagnosis and for relieving intracranial hypertension. Some tumors (i.e., lymphoma or germinoma) are radiosensitive and their surgical removal is excluded [3].

Intraventricular endoscopic surgery has an integral and expanding role in the management of patients with brain tumors. Established applications exist for tumor biopsy, concordant CSF diversion, tumor cyst decompression, and colloid cyst removal. This surgery also offers the possibility of employing ETV for the treatment of associated hydrocephalus, instead of VP shunting, a procedure that may play a role in the dissemination of some tumors, such as pineoblastomas and germ cell tumors, into the peritoneum [14].

In accordance with the literature [1, 16], in the present series endoscopy was found to be safe and effective—without any relevant postoperative morbidity—for reconstructing CSF pathways and restoring CSF flow, and for providing ETV, septostomy, tumor resection, or other endoscopic procedures. In patients affected by malignant tumors, neuroendoscopy can be performed to control intracranial hypertension before the patients start adjuvant chemotherapy or radiotherapy. Because of the tumor site these patients are frequently admitted with intracranial hypertension and a low KPS, which creates a challenge for any kind of treatment. After endoscopic procedures the reduction of intracranial pressure and improvement of the KPS is made possible, depending on the histology, adjuvant therapy, or microsurgery. Furthermore, in tectal glioma or radionecrosis ETV can be employed as the only surgical procedure without any other therapy.