Keyhole endoscopic resection of pediatric craniopharyngioma via a precoronal transventricular transforaminal approach: "small door, big win.": Two-dimensional operative video.
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A 5-year-old boy with progressive headache, seizures, and drowsiness was diagnosed with multicystic calcified craniopharyngioma occupying the third ventricle and reaching up to the lateral ventricle through widened foramen of Monro. A neuroendoscope-assisted transcortical transventricular transforaminal approach was employed. This approach facilitated gross-total excision with no CSF leak, leveraging the shorter and quicker route. Compared with endoscopic transnasal approaches, it avoids nasal morbidity, and in contrast to transcranial approaches, it eliminates brain retraction and neurovascular manipulation. The patient recovered uneventfully with significant symptomatic improvement. Postoperative imaging confirmed near total excision of the tumor, highlighting this approach's superiority for selected intraventricular craniopharyngiomas The video can be found here: https://stream.cadmore.media/r10.3171/2026.7.FOCVID26137.