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Yang Y, Wadhwani N, Shimomura A, Zheng S, Chandler J, Lesniak MS, Tate MC, Sonabend AM, Kalapurakal J, Horbinski C, Lukas R, Stupp R, Kumthekar P, Sachdev S. Long-term outcomes of central neurocytoma - an institutional experience. J Neurooncol 2024:10.1007/s11060-024-04713-3. [PMID: 38865011 DOI: 10.1007/s11060-024-04713-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/11/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Central Neurocytoma (CN) is a rare, WHO grade 2 brain tumor that predominantly affects young adults. Gross total resection (GTR) is often curative for CNs, but the optimal treatment paradigm including incorporation of RT, following subtotal resection (STR) and for scarcer pediatric cases has yet to be established. METHODS Patients between 2001 and 2021 with a pathologic diagnosis of CN were reviewed. Demographic, treatment, and tumor characteristics were recorded. Recurrence free survival (RFS) and overall survival (OS) were calculated according to the Kaplan Meier-method. Post-RT tumor volumetric regression analysis was performed. RESULTS Seventeen adults (≥ 18 years old) and 5 children (< 18 years old) met the criteria for data analysis (n = 22). With a median follow-up of 6.9 years, there was no tumor-related mortality. Patients who received STR and/or had atypical tumors (using a cut-off of Ki-67 > 4%) experienced decreased RFS compared to those who received GTR and/or were without atypical tumors. RFS at 5 years for typical CNs was 67% compared to 22% for atypical CNs. Every pediatric tumor was atypical and 3/5 recurred within 5 years. Salvage RT following tumor recurrence led to no further recurrences within the timeframe of continued follow-up; volumetric analysis for 3 recurrent tumors revealed an approximately 80% reduction in tumor size. CONCLUSION We provide encouraging evidence that CNs treated with GTR or with RT after tumor recurrence demonstrate good long-term tumor control.
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Affiliation(s)
- Yufan Yang
- Department of Radiation Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 1820, Chicago, IL, 60611, USA
- Department of Neurological Surgery, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 2200, Chicago, IL, 60611, USA
- Division of Neuro-Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 675 N St Clair St Floor 20, Chicago, IL, 60611, USA
| | - Nitin Wadhwani
- Department of Pathology and Laboratory Medicine, Stanley Manne Children's Research Institute, Ann and Robert Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, 60611, USA
| | - Aoi Shimomura
- Loyola University Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL, 60153, USA
| | - Shuhua Zheng
- Department of Radiation Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 1820, Chicago, IL, 60611, USA
| | - James Chandler
- Department of Neurological Surgery, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 2200, Chicago, IL, 60611, USA
| | - Maciej S Lesniak
- Department of Neurological Surgery, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 2200, Chicago, IL, 60611, USA
| | - Matthew C Tate
- Department of Neurological Surgery, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 2200, Chicago, IL, 60611, USA
| | - Adam M Sonabend
- Department of Neurological Surgery, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 2200, Chicago, IL, 60611, USA
| | - John Kalapurakal
- Department of Radiation Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 1820, Chicago, IL, 60611, USA
| | - Craig Horbinski
- Department of Pathology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, Ward Building 3-140 W127, 303 E. Chicago Avenue, Chicago, IL, 60611, USA
| | - Rimas Lukas
- Division of Neuro-Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 675 N St Clair St Floor 20, Chicago, IL, 60611, USA
| | - Roger Stupp
- Department of Neurological Surgery, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 2200, Chicago, IL, 60611, USA
- Division of Neuro-Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 675 N St Clair St Floor 20, Chicago, IL, 60611, USA
| | - Priya Kumthekar
- Division of Neuro-Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 675 N St Clair St Floor 20, Chicago, IL, 60611, USA
| | - Sean Sachdev
- Department of Radiation Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 1820, Chicago, IL, 60611, USA.
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Zhang L, Xue J, Liu A, Li X. Adult Central Neurocytomas: Clinical Features and Long-Term Treatment Outcomes in Different Age Groups. World Neurosurg 2024; 186:e630-e638. [PMID: 38604535 DOI: 10.1016/j.wneu.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Central neurocytomas (CNs) usually occur in young adults, and the clinical characteristics and surgical outcomes of patients in different age groups may be different. METHODS This study was undertaken to compare the clinical and long-term treatment outcomes of patients with CNs in younger and older adult age groups. RESULTS Eighty consecutive adults with CNs were included, with a mean presentation age of 28.4±7.6 years (range: 19-66 years). Thirty (37.5%) patients were <27 years old, and they tended to manifest with multiple symptoms (P = 0.002), increased intracranial pressure (ICP) symptoms (P = 0.036), an acute clinical course (P = 0.037), worse preoperative neurologic function (P = 0.023), and a larger lesion size and volume (P = 0.004 and 0.007, respectively) than their older age counterparts (≧27 years). An older onset age (P = 0.005) or age ≧27 years (P = 0.014) and worsened Karnofsky Performance Status (KPS) scale (P = 0.040) immediately after microsurgery were associated with unimproved long-term outcomes. CONCLUSIONS CNs in younger adult patients behave differently from those in the older age group. Surgery can halt neurologic deterioration and ensure satisfactory outcomes.
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Affiliation(s)
- Liang Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangfeng Xue
- Department of Health Management Center, Yubei Hospital, Chongqing, China
| | - Angsi Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueji Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Khowal S, Zhang D, Yong WH, Heaney AP. Whole-exome sequencing reveals genetic variants that may play a role in neurocytomas. J Neurooncol 2024; 166:471-483. [PMID: 38319496 DOI: 10.1007/s11060-024-04567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Neurocytomas (NCs) are rare intracranial tumors that can often be surgically resected. However, disease course is unpredictable in many patients and medical therapies are lacking. We have used whole exome sequencing to explore the molecular etiology for neurocytoma and assist in target identification to develop novel therapeutic interventions. METHODS We used whole exome sequencing (WES) to compare the molecular landscape of 21 primary & recurrent NCs to five normal cerebellar control samples. WES data was analyzed using the Qiagen Clinical Insight program, variants of interest (VOI) were interrogated using ConSurf, ScoreCons, & Ingenuity Pathway Analysis Software to predict their potential functional effects, and Copy number variations (CNVs) in the genes of interest were analyzed by Genewiz (Azenta Life Sciences). RESULTS Of 40 VOI involving thirty-six genes, 7 were pathogenic, 17 likely-pathogenic, and 16 of uncertain-significance. Of seven pathogenic NC associated variants, Glucosylceramidase beta 1 [GBA1 c.703T > C (p.S235P)] was mutated in 5/21 (24%), Coagulation factor VIII [F8 c.3637dupA (p.I1213fs*28)] in 4/21 (19%), Phenylalanine hydroxylase [PAH c.975C > A (p.Y325*)] in 3/21 (14%), and Fanconi anemia complementation group C [FANCC c.1162G > T (p.G388*)], Chromodomain helicase DNA binding protein 7 [CHD7 c.2839C > T (p.R947*)], Myosin VIIA [MYO7A c.940G > T (p.E314*)] and Dynein axonemal heavy chain 11 [DNAH11 c.3544C > T (p.R1182*)] in 2/21 (9.5%) NCs respectively. CNVs were noted in 85% of these latter 7 genes. Interestingly, a Carboxy-terminal domain RNA polymerase II polypeptide A small phosphatase 2 [CTDSP2 c.472G > A (p.E158K)] of uncertain significance was also found in > 70% of NC cases. INTERPRETATION The variants of interest we identified in the NCs regulate a variety of neurological processes including cilia motility, cell metabolism, immune responses, and DNA damage repair and provide novel insights into the molecular pathogenesis of these extremely rare tumors.
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Affiliation(s)
- Sapna Khowal
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
| | - Dongyun Zhang
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
| | - William H Yong
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, 92868, USA
| | - Anthony P Heaney
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA.
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA.
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Dharmasaroja P. Episodic Headache, Periorbital Pain, and Multifocal Paresthesias as Presenting Symptoms of Central Neurocytoma: A Case Report. Cureus 2023; 15:e35334. [PMID: 36974242 PMCID: PMC10039140 DOI: 10.7759/cureus.35334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
Central neurocytoma (CN) is a rare intraventricular tumor. The common presenting symptoms of CN are headache, vomiting, and visual disturbance, which results from increased intracranial pressure. This report presents a case of CN with unusual clinical presentations. A 25-year-old female with CN presented with a one-day history of unilateral headache, ipsilateral periorbital pain, multifocal paresthesias, and vomiting. Magnetic resonance images showed an intraventricular mass with a soap-bubble appearance and numerous cystic areas typical for CN, causing obstructive hydrocephalus and a midline shift. After one night of rest, her headache, periorbital pain, and paresthesias disappeared. It is possible that the tumor could be mobile with regard to the patient's head position, causing occasional obstruction of the foramen of Monro. Due to the tumor size, which was larger than 4 centimeters, the surgical approach with either gross tumor resection or subtotal resection plus adjuvant radiotherapy should be carefully considered.
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Zhang Z, Yu J, Zhang C, Pang X, Wei Y, Lv Q, Chen H, Jin X, Zhan R. Clinical prognostic factors for central neurocytoma and subgroup analysis of different treatment measures: A SEER database-based retrospective analysis from 2003 to 2019. Front Oncol 2023; 12:1014506. [PMID: 36686752 PMCID: PMC9852998 DOI: 10.3389/fonc.2022.1014506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose The study aimed to identify clinical prognostic factors affecting overall survival (OS) in patients with central neurocytoma (CN) and to determine independent prognostic factors in the subgroups of different treatment modalities using a retrospective analysis based on the SEER database from 2003 to 2019. Materials and methods Data regarding patients with CN, including basic clinical characteristics, treatment measures, and prognosis follow-up, were extracted from the SEER database. The prognostic variables for all patients were assessed using log-rank test as well as univariate and multivariate analyses based on the Cox proportional hazards model. The same statistical methods were used for analysis in different subgroups of gross total resection (GTR), subtotal resection (STR), no surgery, radiotherapy (RT), and no RT. Results In total, 413 patients were enrolled in this study. Tumor size, primary site surgery, and RT were independent prognostic factors in all patients with CN. In subgroup analyses, RT was not an independent prognostic factor in patients with GTR. However, sex and race were independent prognostic factors in patients with STR. Additionally, tumor size was an independent prognostic factor in patients who did not undergo surgery. Furthermore, sex and primary site were independent prognostic factors in patients who received RT. Size and primary site surgery were independent prognostic factors in patients without RT. Conclusion In our study, patients with small tumors or GTR or those who did not receive RT showed a better prognosis. GTR was the preferred treatment for CN. RT was not recommended for patients after GTR. Men and African American showed certain advantages after STR surgery. Tumors with a size of >4 cm were recommended for active treatment. In the RT subgroup, patients with tumors outside the ventricle or women had a poorer prognosis than those with tumors within the ventricle or men, respectively. These findings will help clinicians and patients understand the treatment and prognosis of CN visually and intuitively.
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Affiliation(s)
- Zibin Zhang
- Department of Neurosurgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianbo Yu
- Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Zhang
- Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Pang
- Department of Neurosurgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuyu Wei
- Department of Neurosurgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingping Lv
- Department of Neurosurgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huai Chen
- Department of Neurosurgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuhong Jin
- Department of Neurosurgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China,*Correspondence: Renya Zhan, ; Xuhong Jin,
| | - Renya Zhan
- Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,*Correspondence: Renya Zhan, ; Xuhong Jin,
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Comparison of surgery with or without adjuvant radiotherapy in treating central neurocytoma: a single-center retrospective real-world study. J Neurooncol 2022; 160:455-462. [DOI: 10.1007/s11060-022-04164-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 10/31/2022]
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Bramantyo DF, Ariyanto DO, Prihastomo KT, Ardhini R, Murtadho M, Prihharsanti CHN. Radiotherapy Protocol of Central Neurocytoma for Resource-limited Settings in the Absence of Official Guidelines: A Case Report and Review of the Literature. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Central neurocytoma (CN) is one of the rarest brain tumors which can cause considerable threats to the patient. Studies and trials regarding its treatment are scarce, and no official guidelines are dedicated to this disease. The main principle of treatment generally consists of surgery and radiotherapy. The choice of radiotherapy is divided into conventional fractionated radiotherapy and stereotactic radiosurgery (SRS). However, access to SRS in developing countries such as Indonesia is still limited.
AIM: We report a case delineating the timeline and process of treatment in CN with a review of the literature.
METHODS: We report the case of a 29-year-old woman with a solid inhomogeneous mass (AP 5.63 × CC 5.36 × LL 5.16 cm) in the right ventricle, attached to the septum pellucidum, as displayed on the magnetic resonance imaging (MRI). The patient had been vomiting for the past three weeks and presented with bidirectional horizontal nystagmus.
RESULTS: Cognitive evaluation with Montreal Cognitive Assessment (MoCA-Ina) demonstrated a mild cognitive impairment. Biopsy was performed, and pathology analysis revealed some cells with fibrillary background and some with a honeycomb-like appearance. The immunohistochemistry staining showed positive results with synaptophysin and neuronal nuclear protein. According to the WHO classification of the central nervous system tumors, the profile favored CN Grade II. Subtotal resection (STR) was performed to reduce the tumor mass, which was measured with MRI 2-month post-surgery (AP 4.09 × CC 3.01 × LL 4.13 cm) and then followed by an external radiation program. Using intensity modulated radiation therapy (IMRT), a total dose of 54 Gy was given in 27 fractions, with the average planning target volume of 54.3 Gy. There was a minuscule reduction in tumor mass as seen in post-radiotherapy MRI (AP 4.00 × CC 3.86 × LL 3.63 cm). After the last session and at the 18-month follow-up, the patient did not have any complaints or abnormalities during clinical assessment. Reevaluation using MoCA-Ina showed an improved cognitive function.
CONCLUSIONS: In line with recent evidence, we demonstrated that STR followed by IMRT with the dosage of 54 Gy in 27 fractions was a feasible treatment strategy for CN that resulted in cognitive improvement, with no side effects.
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Central Neurocytoma with Hemorrhagic Presentation Case Report and Review of the Literature. Case Rep Surg 2022; 2022:9731987. [PMID: 35310930 PMCID: PMC8930273 DOI: 10.1155/2022/9731987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
Central neurocytoma (CN) is slow-growing rare intraventricular tumor that represents 0.25-0.5% of all intracranial tumors in adults. Typically, it is seen in young adults, yet with surgical resection, it has excellent prognosis. Due to CN rarity and its feature similarities with other common tumors, misdiagnosis can be an issue. With no pathognomonic clinical features of CN, a proper diagnosis can be achieved by radiological imaging, magnetic resonance spectroscopy, histopathology assessment, and immunohistochemistry. Therefore, this is a case report of a 17-year-old male who presented with right lateral ventricular CN with intraventricular hemorrhage. Subtotal tumor resection was carried out via right transcortical approach. Subtle improvement for the patient condition was noted.
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Cao D, Chen Y, Guo Z, Ou Y, Chen J. Clinical Outcome After Microsurgical Resection of Central Neurocytoma: A Single-Centre Analysis of 15 Years. Front Neurol 2022; 12:790641. [PMID: 35002932 PMCID: PMC8727338 DOI: 10.3389/fneur.2021.790641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: This study aimed to explore the immediate postoperative and long-term outcomes of central neurocytoma (CN) based on 15 years of experience in our institution. Methods: This single-institution study collected data of 43 patients with CN who underwent surgery between 2005 and 2020. We reviewed data of clinical, immediate postoperative outcome, and long-term outcome of patients. More specifically, we divided complications into neurological and regional complications groups. Results: Among the 43 patients with CN who underwent surgery, the transcortical (72.1%) or transcallosal (25.6%) approach was used. There were 18 patients (41.9%) who complained about postoperative neurological complications, including motor weakness (25.6%), memory deficit (18.6%), aphasia (7.0%), and seizure (4.7%). In addition, 18 patients suffered postoperative regional complications such as hydrocephalus (2.3%), hematoma (34.9%), infection (4.7%), and subcutaneous hydrops (2.3%). Only one-quarter of patients had suffered permanent surgical complications. The majority of patients recovered from the deficit and could turn back to normal life. There were no significant differences in the clinical outcomes between transcortical and transcallosal approaches. At a median follow-up of 61.8 months, the 5-year overall survival and progression-free survival were 87.0 and 74.0%, respectively. A multivariate Cox model analysis showed that the extent of resection was not related to progression-free survival. However, the extent of resection was significantly associated with overall survival, and gross total resection decreased the risk of death. Conclusions: Patients with CN show favorable outcomes after surgery. The transcortical and transcallosal approaches have similar postoperative complication rates and long-term follow-up outcomes. In terms of long-term prognosis, maximal safety resection should be the first choice of CN.
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Affiliation(s)
- Dan Cao
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Chen
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhengqian Guo
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yibo Ou
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Chen
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Konovalov A, Maryashev S, Pitskhelauri D, Siomin V, Golanov A, Dalechina A. The last decade's experience of management of central neurocytomas: Treatment strategies and new options. Surg Neurol Int 2021; 12:336. [PMID: 34345477 PMCID: PMC8326110 DOI: 10.25259/sni_764_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background: The purpose of the presented work is to evaluate the last decade’s experience in surgical management of central neurocytoma (CN) and elucidate on the treatment strategies and new options. Methods: The current series consists of the remaining 125 patients (70 females and 55 males) operated on during the past decade from 2008 to 2018. Most tumors were resected through transcortical (n = 76, 61%), or transcallosal (n = 40, 32%) approaches. In 5 (4%) patients with predominantly posterior location of the tumor, non-dominant superior parietal lobule approach was utilized. Both approaches (transcortical + transcallosal) were used in 4 (3%) of cases. Seven consecutive patients with large CN underwent prophylactic intraventricular stenting to prevent hydrocephalus. Results: Gross total resection was achieved in 45 patients (36%), subtotal resection (STR) in 40 (32%) cases. After surgery, 63 (50%) patients had neurocognitive problems, including disorientation, attention deficit, global amnesia, short-term memory deficits, and perceptual motor and social cognition problems. A total of 26 patients (21%) had postoperative hemorrhage in the resection bed. Obstructive hydrocephalus was noted in 25 (20%) patients. The entrapment of the occipital and/or temporal horns was observed in seven cases. None of the seven patients with prophylactic intraventricular stents required shunting. Conclusion: Although high rates of gross total or STR can be expected, the mortality and morbidity remain significant even in the modern neurosurgical era. Prophylactic intraventricular stenting in patients with large posteriorly located tumors with hydrocephalus may prevent ventricular entrapment and shunting. The main risk factors for recurrence are presence of residual disease and Ki-67 index over 5%. Recurrent symptomatic tumors should be treated surgically, whereas asymptomatic progression can be managed with stereotactic radiosurgery. Both treatment modalities are associated with low risk of complications and high tumor control rates.
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Affiliation(s)
- Alexander Konovalov
- Department of Neurosurgery, N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Sergey Maryashev
- Department of Neurosurgery, N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - David Pitskhelauri
- Department of Neurosurgery, N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Vitaly Siomin
- Department of Neurosurgery, Baptist Hospital of Miami, Miami Neuroscience Institute, Miami, Florida, United States
| | - Andrey Golanov
- Department of Radiation therapy and Radiosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Aleksandra Dalechina
- Gamma Knife Center, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
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Han S, Yang Z, Yang Y, Qi X, Yan C, Yu C. Individual Treatment Decisions for Central Neurocytoma. Front Neurol 2020; 11:834. [PMID: 32922351 PMCID: PMC7457043 DOI: 10.3389/fneur.2020.00834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Central neurocytomas (CNs) are rare, and this has resulted in a paucity of information and a lack of clarity regarding their optimal management. This study aimed to explore individual treatment strategies for CNs and the benefits of these strategies for patients. Methods: This single-center study retrospectively analyzed data from 67 patients with CNs who underwent surgery. Based on the extent of resection, patients were divided into complete and incomplete resection groups. The patients were followed, and overall survival (OS) and progression-free survival (PFS) were determined. Results: Of 55 patients (82.1%) who underwent complete resections, 24 received radiotherapy (24/55, 43.6%). Of 12 patients who underwent incomplete resections, 9 (9/12, 75.0%) received radiotherapy. The OS (p = 0.003) and PFS (p = 0.006) intervals were significantly longer in the complete resection group than in the incomplete resection group. Postoperative radiotherapy did not affect OS (p = 0.129) or PFS (p = 0.233) in the complete resection group. In the incomplete resection group, postoperative adjuvant radiotherapy prolonged patient survival significantly (p = 0.021). PFS was significantly longer among patients who underwent complete resection without radiotherapy than in those who underwent incomplete resection followed by radiotherapy (p = 0.034). Functional dependence on admission, which was defined as a Karnofsky Performance Status score <70, was an independent risk factor associated with long-term survival in patients with CN. Postoperative complications were not associated with the amount of tumor resected. The prognosis of patients aged ≥ 50 years was relatively poor. The atypical CN recurrence rate was relatively high (7.8%). Conclusions: To protect function as much as possible, complete tumor resection should be the first choice of treatment for CN. After gross total resection, adjuvant radiotherapy is not acceptable. Postoperative adjuvant radiotherapy improves the prognosis of patients who have undergone incomplete tumor resections. Adjuvant radiotherapy is not recommended after complete resections of atypical CNs, and close follow-up with imaging is required. Our findings can help guide decision-making regarding the treatment of CNs and could potentially maximize the benefits of treatment for patients with CN.
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Affiliation(s)
- Song Han
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zuocheng Yang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yakun Yang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xueling Qi
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Changxiang Yan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chunjiang Yu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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Virbel G, Cebula H, Coca A, Lhermitte B, Bauchet L, Noël G. [Choice optimisation of radiation therapy technique for central neurocytomas from literature data]. Cancer Radiother 2020; 24:882-891. [PMID: 32753237 DOI: 10.1016/j.canrad.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/28/2020] [Accepted: 03/11/2020] [Indexed: 12/31/2022]
Abstract
Neurocytomas represent 0,25 to 0,5 of brain tumours. These tumours have neuronal differentiation. It's a young adult disease. The main treatment is neurosurgery. The place of other therapies is still unclear, noticeably with regards to radiotherapy. This review aim is to determine the place and the modalities of radiotherapy in the management of neurocytomas. A literature search using PubMed allowed to select the most relevant studies. Finally, 22 studies were selected according to pre-established criteria to answer the problem. All studies were retrospective studies except one. The analysis conclusion defined radiotherapy as a treatment of choice in selected patients, when surgical resection was incomplete or when tumour was atypical.
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Affiliation(s)
- G Virbel
- Département de radiothérapie, ICANS, 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - H Cebula
- Département de neurochirurgie, hôpital de Hautepierre, 1, rue Molière, 67200 Strasbourg, France
| | - A Coca
- Département de neurochirurgie, hôpital de Hautepierre, 1, rue Molière, 67200 Strasbourg, France
| | - B Lhermitte
- Service d'anatomopathologie, hôpital de Hautepierre, 1, rue Molière, 67200 Strasbourg, France
| | - L Bauchet
- Service de neurochirurgie, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; Inserm, U1051, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - G Noël
- Département de radiothérapie, ICANS, 17, rue Albert-Calmette, 67200 Strasbourg, France.
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Mahavadi AK, Patel PM, Kuchakulla M, Shah AH, Eichberg D, Luther EM, Komotar RJ, Ivan ME. Central Neurocytoma Treatment Modalities: A Systematic Review Assessing the Outcomes of Combined Maximal Safe Resection and Radiotherapy with Gross Total Resection. World Neurosurg 2020; 137:e176-e182. [DOI: 10.1016/j.wneu.2020.01.114] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/22/2022]
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Konovalov AN, Maryashev SA, Pitskhelauri DI, Lubnin AY. [Central neurocytomas: surgical treatment outcomes and new trends and approaches in the treatment]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 83:6-20. [PMID: 32031164 DOI: 10.17116/neiro2019830616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM Central neurocytomas of the brain are rare benign tumors of the cerebral lateral ventricles. The main treatment for them is surgical resection. Resection provides a long-term relapse-free period, but surgical intervention is associated with a number of significant difficulties due to the location, size, and blood supply features of these tumors. The postoperative period is often accompanied by hemorrhagic complications, impaired cerebrospinal fluid circulation, and worsening of neurological symptoms. PURPOSE The study purpose was to evaluate the effectiveness of surgical treatment in neurocytoma patients, assess the risk of complications after neurocytoma resection, and develop techniques for their prevention. MATERIAL AND METHODS The paper presents surgical treatment outcomes in 115 patients with central neurocytomas for the period from 2008 to 2017. The choice of a surgical approach and the surgical features are described in detail, and the radicality is assessed with allowance for the location and size of tumors. The immediate clinical outcomes of treatment are evaluated, complications are analyzed, and methods for prevention and treatment of complications are described. RESULTS Analysis of the data revealed that the tumor was resected totally in 41 (36%) patients, subtotally - in 37 (32%), and partially in 37 (32%). The most common and dangerous complications were as follows: CSF circulation occlusion with the development of hydrocephalus in 23 (20%) patients; hemorrhage into the residual tumor, which required immediate revision of the surgical wound in most cases, in 25 (22%) patients. In the early postoperative period after tumor resection, almost all patients developed deterioration of condition with transient worsening of cerebral and focal symptoms. The degree and duration of this worsening were different. In 50% of cases, the postoperative condition was characterized by reduced voluntary activity, drowsiness or jitteriness, and motor or speech anxiety. CONCLUSION We consider resection of neurocytomas as the main treatment option, despite the potential complications and effects of the operation.
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Affiliation(s)
| | | | | | - A Yu Lubnin
- Burdenko Neurosurgical Center, Moscow, Russia
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Alqroom RY, Wesam K, Hanada K, Anan Q, Mohamad AZ, Lamees A, Rima N, Qamar M, Faisal AS, Maher E, Wagdy AK, Al Shurbaji AA. Delving Inside the Enigmatic Central Neurocytoma: Electronic Hospital Database Retrieval. Acta Inform Med 2020; 28:146-151. [PMID: 32742069 PMCID: PMC7382777 DOI: 10.5455/aim.2020.28.146-151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Central neurocytomas (CNCs) appear as a rare benign intraventricular lesions involving <0.5% of primary brain tumors. There are no consensus guidelines for the optimal management strategy, so that this entity still enigmatic. Aim: This review aims to highpoint the entity of central neurocytoma in patients managed by our department and the unique surgical considerations, to review the epidemiology and demographics in patients treated in our institution. Methods: This retrospective analysis was conducted by reviewing tall patients managed at King Hussein Medical Center (KHMC) and their medical records. Patient reports were retrieved from the electronic hospital database for a 14-year period (2004 _ 2018). The review was permitted by the Royal Medical Services Institutional ethics committee. As this study was a retrospective chart review, the requirement for consent was waived. Results: Study revealed 33- patients who had Central neurocytoma as the underlying cause for admission. Of the final population 42.4% of the patients were males. Mean age at diagnosis was 29.48±9.78 years. Two cases were extra-ventricular, to cases were anaplastc. Only one patient developed recurrence. Conclusion: We have one the large series of Central neurocytomas in literature. They are benign and total resection is feasible. New adjuvant therapies are flourishing. Supplementary studies are required clarify the cardinal factors responsible for its pathogenesis; diagnosis; and to consolidate management approaches protocol.
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Affiliation(s)
- Rami Y Alqroom
- Neurosurgery Department, King Hussein Medical Center, Royal medical services, Amman-Jordan
| | - Khraisat Wesam
- Anesthesia Department, King Hussein Medical Center, Royal medical services, Amman-Jordan
| | - Krashan Hanada
- Anesthesia Department, King Hussein Medical Center, Royal medical services, Amman-Jordan
| | - Qabaha Anan
- Anesthesia Department, King Hussein Medical Center, Royal medical services, Amman-Jordan
| | - Al-Zoubi Mohamad
- Neurosurgery Department, King Hussein Medical Center, Royal medical services, Amman-Jordan
| | - Arabiyat Lamees
- Plastic Surgery Department, Farah Medical Center, Royal medical services, Amman-Jordan
| | - Nserat Rima
- Pathology Department at Princess Iman Research and Laboratory Sciences Center, Amman, Jordan
| | - Malabeh Qamar
- Radiology Department, King Hussein Medical Center, Royal medical services, Amman, Jordan
| | - Al Shurbaji Faisal
- Neurosurgery Department, King Hussein Medical Center, Royal medical services, Amman-Jordan
| | - Elayyan Maher
- Neurosurgery Department, King Hussein Medical Center, Royal medical services, Amman-Jordan
| | - Al-Kadasi Wagdy
- Neurosurgery Department, King Hussein Medical Center, Royal medical services, Amman-Jordan
| | - Amer A Al Shurbaji
- Neurosurgery Department, King Hussein Medical Center, Royal medical services, Amman-Jordan
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What is causing this patient's sudden headache? JAAPA 2019; 32:54-56. [PMID: 31241613 DOI: 10.1097/01.jaa.0000558376.39352.2d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chandshah MI, Sadashiva N, Konar S, Devi BI. Central Neurocytoma Presenting with Bleed and Obstructive Hydrocephalus: A Rare Presentation. Asian J Neurosurg 2019; 14:919-921. [PMID: 31497129 PMCID: PMC6703028 DOI: 10.4103/ajns.ajns_84_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Central neurocytomas (CNs) occur typically in the lateral ventricle, adjacent to the septum pellucidum and foramen of Monro. The clinical presentation varies and many are incidentally detected. Incidence of spontaneous hemorrhage at presentation is rare. We hereby report a case of the intraventricular lesion with bleed which was operated on an emergency basis as it caused obstructive hydrocephalus and the patient was in altered sensorium. The exact cause of hemorrhage in CNs is not known, and the previously discussed explanations are discussed.
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Affiliation(s)
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Subhas Konar
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Richardson AM, Armstrong VL, Gernsback JE, Gultekin SH, Komotar RJ. Central Neurocytoma: Rare Presentation in Fourth Ventricle and Review of Literature. World Neurosurg 2018; 123:357-361. [PMID: 30579012 DOI: 10.1016/j.wneu.2018.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 02/01/2023]
Abstract
Central neurocytomas are rare tumors, typically found in the third ventricle. We present the unusual case of a fourth ventricular central neurocytoma in a 70-year-old female presenting with imbalance and headaches, with an enhancing fourth ventricular mass on imaging. We examine the details of her clinical presentation, imaging characteristics, histopathologic analysis, and postoperative course. We performed a critical literature review of fourth ventricular central neurocytoma, identifying 6 previously reported cases. In contrast to our patient, the majority of these cases were in young males. The 2 females with fourth ventricular neurocytoma developed it at a much later age (mean 63.5 years) than their male counterparts (mean 22.8 years; P = 0.005). Despite being a rare cause for a fourth ventricular lesion, given the appropriate clinical context and radiographic findings, this should remain part of the differential diagnosis.
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Affiliation(s)
| | | | | | - Sakir H Gultekin
- Department of Pathology, University of Miami, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
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Park SJ, Jung TY, Kim SK, Lee KH. Tumor control of third ventricular central neurocytoma after gamma knife radiosurgery in an elderly patient: A case report and literature review. Medicine (Baltimore) 2018; 97:e13657. [PMID: 30558064 PMCID: PMC6320117 DOI: 10.1097/md.0000000000013657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Central neurocytoma is rare benign tumor that occurs in high probability in young adults in the lateral ventricle. Herein, we report an unusual case of an elderly woman who was diagnosed with central neurocytoma isolated to the third ventricle. This deeply located tumor was effectively treated using gamma knife radiosurgery (GKR). PATIENT CONCERNS A 79-year-old woman was admitted to hospital with gait disturbance and cognitive dysfunction. DIAGNOSIS Brain magnetic resonance imaging (MRI) revealed a homogenously enhancing multilobulated mass in the posterior third ventricle measuring 1.8 cm in size. The tumor was diagnosed as a central neurocytoma isolated to the third ventricle. INTERVENTIONS Neuronavigation-guided endoscopic third ventriculostomy and biopsy were performed. One week following surgery, GKR was performed using a prescribed dose of 14 Gy with 50% isodose lines, and a target volume of 1.62 cc. OUTCOMES Three months after GKR, brain MRI revealed a decrease in the size (to 1.4 cm) of the multilobulated strong enhancing mass in the posterior third ventricle, and the patient's symptom of confusion was improved. LESSONS Previous studies have reported that tumors in unusual locations, such as those isolated to the third ventricle, are different according to age, either in young children or elderly individuals. Although complete surgical resection is an effective treatment for central neurocytoma, it is often difficult to approach these tumors through surgery. GKR could, therefore, be an alternative primary treatment option for deeply located central neurocytomas in elderly patients.
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Affiliation(s)
| | | | | | - Kyung-Hwa Lee
- Pathology, Chonnam National University Medical School, Chonnam National University Hospital and Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea
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Elayouty AED, Hamad A, Ghobashi A. Transcortical approach to lateral ventricular central neurocytomas: a case series and review of the literature. EGYPTIAN JOURNAL OF NEUROSURGERY 2018. [DOI: 10.1186/s41984-018-0023-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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In Reply to Letter to the Editor Regarding “Clinical Features, Treatment, and Long-Term Outcomes of Central Neurocytoma: 20-Year Experience at a Single Center”. World Neurosurg 2018; 111:434. [DOI: 10.1016/j.wneu.2017.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/19/2022]
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Letter to the Editor Regarding “Clinical Features, Treatment, and Long-Term Outcomes of Central Neurocytoma: 20-Year Experience at a Single Center”. World Neurosurg 2018; 111:433. [DOI: 10.1016/j.wneu.2017.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022]
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