Operative management of intraventricular central neurocytomas: an analysis of a surgical experience with 32 cases

Abstract

ABSTRACTpatients with central neurocytoma (CN) (11). However, the proximity to the deep critical neural and vascular structures and rich blood supply increase the risk of surgical treatment. Resection of CN is still a challenging procedure for most neurosurgeons. The best selection of the common surgical approaches including transcortical transventricular approach and interhemispheric-transcallosal transventricular approach is still controversial, and the optimal selection and timing of adjuvant radiotherapy and chemotherapy also remain unclear. █ InTRODuCTIOnCentral neurocytomas (CNs) are rare brain tumors of young adults, typically located in deep midline structures near the foramen of Monro (28). The tumors were first described as a distinct clinicopathologic entity by Hassoun et al. in 1982 (9, 11). These well-differentiated tumors with neuronal differentiation have an indolent clinical course. gross total resection (GTR) is the first optimal treatment option for most AIM: To better understand the clinical characteristics of central neurocytoma (CN), as well as to assess the optimum therapeutic schedule. MATERIAl and METhODS:This was a retrospective study of 32 patients with CN who visited our department between January 2008 and January 2013. We analyzed the clinical and radiological presentations, tumor characteristics, surgical strategies, and the prognosis. RESulTS:We performed operation guided by combined intraoperative magnetic resonance imaging (iMRI) and neuronavigation in 25 patients. The iMRI detected residual tumor in 9 cases, and further resection was performed in 5 cases. Total and nearly total tumor resection was achieved in 29 cases (91%). There was no significant difference between transcortical and transcallosal approaches in complications. Two cases (6%) with recurrence received respectively repeat salvage surgery and radiosurgery at 46 and 50 months after surgery. Thirty patients (94%) had excellent functional outcome (Karnofsky Performance Score ≥80) and 28 patients (88%) resumed their occupations.COnCluSIOn: Our study demonstrates radical surgery with excellent neurological outcomes is the primary treatment of CN. The techniques of resection guided by combined iMRI and neuronavigation seems to enable a higher complete resection rate and reduce the morbidity rate during surgery. We suggest careful clinical observation after initial surgery, and repeat salvage surgery or radiosurgery for recurrent CN.

The last decade’s experience of management of central neurocytomas: Treatment strategies and new options

“…Our GTR rate is lower than in the largest published series up to date by Chen et al . [ 8 ] It is felt to be mainly due to larger size of the lesions at presentation in our report. In the present study, 69 of 125 patients (55%) presented with large or giant tumors.…”

“…[ 19 , 38 ] In the last decade, however, a higher number of patients underwent more radical resections, ranging from 71% to 91% with acceptable morbidity. [ 8 , 23 , 41 ]…”

“…Other factors include their large size at presentation and early involvement of such critical structures as thalami and fornices. [ 8 , 19 , 23 , 26 , 29 , 34 , 36 , 38 , 51 ] The current consensus is that aggressive resection is not recommended if the tumor infiltrates the fornices, thalami, or encases the large intraventricular veins.…”

“…Therefore, if feasible, interhemispheric transcallosal route should be the approach of choice, as it provides the least disruptive anatomical corridor associated with smaller risk of approach related complications. [ 8 ]…”

“…[ 19 , 38 ] In the last decade, however, a higher number of patients underwent more radical resections, ranging from 71% to 91% with acceptable morbidity. [ 8 , 23 , 41 ] In this manuscript, the authors systematized the results of surgical treatment of CN in the past decade from 2008 to 2018. The main focus of this largest surgical series of patients with CN to date is the analysis of anatomy and location of the tumor, proper selection of surgical approaches, and evaluation of outcomes.…”