Abstract
BACKGROUND: Intraventricular meningiomas (IVMs) are a rare subtype of brain tumors. Typically slow growing, these tumors can occasionally reach a substantial size, causing ventricular obstruction and hydrocephalus. Resection remains the treatment of choice; however, the deep location and proximity to critical neurovascular structures can pose significant challenges. Various surgical strategies and adjuncts have been described. Here, the authors highlight the benefits of early intraoperative tumor devascularization to minimize blood loss and enable safe, efficient removal through a minimally disruptive transsulcal approach. OBSERVATIONS: A 59-year-old woman presented with symptoms of increased intracranial pressure due to a large atrial IVM causing temporal horn entrapment. The tumor was hypervascular, with prominent arterial feeders. Early intraoperative microsurgical devascularization was favored over preoperative embolization, combined with temporary clipping of adjacent arterial feeders and intraoperative neurophysiological monitoring. This strategy facilitated piecemeal gross-total tumor resection within a relatively short surgical duration, minimizing brain retraction. The patient was neurologically intact after gross-total resection. LESSONS: Early and strategic tumor devascularization is an effective approach to achieve safe and efficient resection of large intraventricular tumors with minimal brain retraction. https://thejns.org/doi/10.3171/CASE2569.