Traditional Open and Neuro-Endoscopic Approaches to Intraventricular Pathology

Lesions located within the ventricular system of the brain have long represented some of the most technically challenging targets for the surgeon. With the introduction of the operating microscope, the dedicated ventricular endoscope, and now subcortical access ports, there have been significant refinements in instrumentation and technique to minimize the morbidity of surgical approach. Regardless of which instruments and technique is chosen, a basic understanding of the established options for approaching the ventricular system is key to planning and executing a safe and effective operation. We review the well-documented approaches (both microsurgical and endoscopic) to the supratentorial ventricular system, providing the reader with a framework for choosing an approach based on surgical target and intervening eloquent tissue. This same framework, with some modification to account for primarily trans-sulcal approaches, can be used to plan a port-based surgery.