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Haider AS, McCutcheon IE, Ene CI, Fuller GN, Schomer DF, Gule-Monroe M, DeMonte F, Ferguson SD, Lang FF, Prabhu SS, Raza SM, Suki D, Weinberg JS, Sawaya R. Subependymomas of the fourth ventricle: To operate or not to operate? J Clin Neurosci 2023; 118:147-152. [PMID: 37944358 DOI: 10.1016/j.jocn.2023.10.025] [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: 08/14/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND There is a paucity of literature regarding the clinical characteristics and management of subependymomas of the fourth ventricle due to their rarity. Here, we describe the operative and non-operative management and outcomes of patients with such tumors. METHODS This retrospective single-institution case series was gathered after Institutional Review Board (IRB) approval. Patients diagnosed with a subependymoma of the fourth ventricle between 1993 and 2021 were identified. Clinical, radiology and pathology reports along with magnetic resonance imaging (MRI) images were reviewed. RESULTS Patients identified (n = 20), showed a male predominance (n = 14). They underwent surgery (n = 9) with resection and histopathological confirmation of subependymoma or were followed with imaging surveillance (n = 11). The median age at diagnosis was 51.5 years. Median tumor volume for the operative cohort was 8.64 cm3 and median length of follow-up was 65.8 months. Median tumor volume for the non-operative cohort was 0.96 cm3 and median length of follow-up was 78 months. No tumor recurrence post-resection was noted in the operative group, and no tumor growth from baseline was noted in the non-operative group. Most patients (89 %) in the operative group had symptoms at diagnosis, all of which improved post-resection. No patients were symptomatic in the non-operative group. CONCLUSIONS Surgical resection is safe and is associated with alleviation of presenting symptoms in patients with large tumors. Observation and routine surveillance are warranted for smaller, asymptomatic tumors.
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Affiliation(s)
- Ali S Haider
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - Ian E McCutcheon
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Chibawanye I Ene
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Donald F Schomer
- Neuroradiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Maria Gule-Monroe
- Neuroradiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Franco DeMonte
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sherise D Ferguson
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sujit S Prabhu
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Shaan M Raza
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Dima Suki
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Raymond Sawaya
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA; Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Doğu H, Akdemir H, Çetin S. Lateral Horizontal Head Position Approach for the Lateral and Anterior Third Ventricles: A Subependymoma Clinical Case and Literature Review. Asian J Neurosurg 2022; 17:642-646. [PMID: 36570767 PMCID: PMC9771625 DOI: 10.1055/s-0042-1757724] [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: 11/05/2022] Open
Abstract
Subependymomas are benign, slow-growing, noninvasive solitary lesions of World Health Organization Grade I cerebral ependymal origin that are rare compared with other types of ependymomas. Anterior third ventricle subependymomas are usually detected during autopsies in cases of sudden death due to acute or intermittent obstruction of the cerebrospinal fluid passage. Different surgical approaches are used for these cerebral lateral and third ventricular lesions. Serious complications can occur, either because of brain edema and acute intracranial pressure due to the lesion itself or the chosen head position and continuous use of brain retractors during the surgical procedure. In this case report, we trust that the surgical principles we applied with the aid of two cotton pads, gravity assist, and lateral horizontal head position, and without continuous use of brain retractors in the third ventricular lesion in the transcallosal interhemispheric approach are safe and secure in preventing perioperative brain edema or early postoperative neurological complications.
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Affiliation(s)
- Hüseyin Doğu
- Department of Neurosurgery, Medicine Hospital, Atlas University, Istanbul, Turkey,Address for correspondence Hüseyin Doğu, MD Medicine HospitalHoca Ahmet Yesevi Cad. No 149, 34460, Bağcılar, İstanbulTurkey
| | - Hidayet Akdemir
- Department of Neurosurgery, Medicine Hospital, Atlas University, Istanbul, Turkey
| | - Sırma Çetin
- Department of Pathology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
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Rincon-Torroella J, Rakovec M, Khalafallah AM, Liu A, Bettegowda A, Kut C, Rodriguez FJ, Weingart J, Luciano M, Olivi A, Jallo GI, Brem H, Mukherjee D, Lim M, Bettegowda C. Clinical features and surgical outcomes of intracranial and spinal cord subependymomas. J Neurosurg 2022; 137:931-942. [PMID: 35148513 DOI: 10.3171/2021.12.jns211643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Subependymomas are low-grade ependymal tumors whose clinical characteristics, radiographic features, and postsurgical outcomes are incompletely characterized due to their rarity. The authors present an institutional case series and a systematic literature review to achieve a better understanding of subependymomas. METHODS Adult patients with histologically confirmed subependymoma or mixed subependymoma-ependymoma surgically treated at a tertiary hospital between 1992 and 2020 were identified. A systematic literature review of the PubMed, Embase, Web of Science, and Google Scholar databases from inception until December 4, 2020, was conducted according to PRISMA guidelines. Data extracted from both groups included demographics, radiographic features, tumor characteristics, management, and follow-up variables. RESULTS Forty-eight unique patients with subependymoma were identified by chart review; of these patients, 8 (16.7%) had mixed subependymoma-ependymoma tumors. The median age at diagnosis was 49 years (IQR 19.8 years), and 26 patients (54.2%) were male. Forty-two patients (87.5%) had intracranial subependymomas, and 6 (12.5%) had spinal tumors. The most common presentation was headache (n = 20, 41.7%), although a significant number of tumors were diagnosed incidentally (n = 16, 33.3%). Among the 42 patients with intracranial tumors, 15 (35.7%) had hydrocephalus, and the most common surgical strategy was a suboccipital approach with or without C1 laminectomy (n = 26, 61.9%). Gross-total resection (GTR) was achieved in 33 cases (68.7%), and 2 patients underwent adjuvant radiotherapy. Most patients had no major postsurgical complications (n = 34, 70.8%), and only 1 (2.1%) had recurrence after GTR. Of 2036 reports initially identified in the systematic review, 39 were eligible for inclusion, comprising 477 patients. Of 462 patients for whom tumor location was reported, 406 (87.9%) were intracranial, with the lateral ventricle as the most common location (n = 214, 46.3%). Spinal subependymomas occurred in 53 patients (11.5%), with 3 cases (0.6%) in multiple locations. Similar to the case series at the authors' institution, headache was the most common presenting symptom (n = 231, 54.0%) among the 428 patients whose presentation was reported. Twenty-seven patients (6.3%) were diagnosed incidentally, and 36 cases (8.4%) were found at autopsy. Extent of resection was reported for 350 patients, and GTR was achieved in 250 (71.4%). Fifteen of 337 patients (4.5%) had recurrence or progression. CONCLUSIONS The authors' case series and literature review demonstrate that patients with subependymoma are well managed with resection and generally have a favorable prognosis.
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Affiliation(s)
| | - Maureen Rakovec
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adham M Khalafallah
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann Liu
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anya Bettegowda
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carmen Kut
- 2Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fausto J Rodriguez
- 3Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon Weingart
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark Luciano
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alessandro Olivi
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George I Jallo
- 4Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida; and
| | - Henry Brem
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Debraj Mukherjee
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 5Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael Lim
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chetan Bettegowda
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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4
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Sakamoto K, Chambers JK, Fujimoto J, Maeda S, Kamishina H. Surgical management of subependymoma in a cat. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Karin Sakamoto
- Joint Department of Veterinary Medicine Faculty of Applied Biological Sciences Gifu University Gifu Japan
| | - James K. Chambers
- Laboratory of Veterinary Pathology Graduate School of Agricultural and Life Sciences The University of Tokyo Tokyo Japan
| | | | - Sadatoshi Maeda
- Joint Department of Veterinary Medicine Faculty of Applied Biological Sciences Gifu University Gifu Japan
- The Animal Medical Centre of Gifu University Gifu University Gifu Japan
- The United Graduate School of Veterinary Sciences Gifu University Gifu Japan
| | - Hiroaki Kamishina
- Joint Department of Veterinary Medicine Faculty of Applied Biological Sciences Gifu University Gifu Japan
- The Animal Medical Centre of Gifu University Gifu University Gifu Japan
- The United Graduate School of Veterinary Sciences Gifu University Gifu Japan
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Haider AS, El Ahmadieh TY, Haider M, Hatanpaa KJ, Pinho MC, Mickey BE, Sawaya R, Fuller GN, Schomer DF, Gule-Monroe M. Imaging characteristics of 4th ventricle subependymoma. Neuroradiology 2022; 64:1795-1800. [PMID: 35426054 PMCID: PMC9365749 DOI: 10.1007/s00234-022-02944-7] [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] [Received: 12/24/2021] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Subependymomas located within the 4th ventricle are rare, and the literature describing imaging characteristics is sparse. Here, we describe the clinical and radiological characteristics of 29 patients with 4th ventricle subependymoma. METHODS This is a retrospective multi-center study performed after Institutional Review Board (IRB) approval. Patients diagnosed with suspected 4th ventricle subependymoma were identified. A review of clinical, radiology, and pathology reports along with magnetic resonance imaging (MRI) images was performed. RESULTS Twenty-nine patients, including 6 females, were identified. Eighteen patients underwent surgery with histopathological confirmation of subependymoma. The median age at diagnosis was 52 years. Median tumor volume for the operative cohort was 9.87 cm3, while for the non-operative cohort, it was 0.96 cm3. Thirteen patients in the operative group exhibited symptoms at diagnosis. For the total cohort, the majority of subependymomas (n = 22) were isointense on T1, hyperintense (n = 22) on T2, and enhanced (n = 24). All tumors were located just below the body of the 4th ventricle, terminating near the level of the obex. Fourteen cases demonstrated extension of tumor into foramen of Magendie or Luschka. CONCLUSION To the best of our knowledge, this is the largest collection of 4th ventricular subependymomas with imaging findings reported to date. All patients in this cohort had tumors originating between the bottom of the body of the 4th ventricle and the obex. This uniform and specific site of origin aids with imaging diagnosis and may infer possible theories of origin.
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Affiliation(s)
- Ali S. Haider
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Tarek Y. El Ahmadieh
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Maryam Haider
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030 USA
| | - Kimmo J. Hatanpaa
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Marco C. Pinho
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Bruce E. Mickey
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Raymond Sawaya
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Gregory N. Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Donald F. Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030 USA
| | - Maria Gule-Monroe
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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6
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Kweh BTS, Rosenfeld JV, Hunn M, Tee JW. Tumor characteristics and surgical outcomes of intracranial subependymomas: a systematic review and meta-analysis. J Neurosurg 2021; 136:736-748. [PMID: 34416731 DOI: 10.3171/2021.2.jns204052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The tumor characteristics and surgical outcomes of intracranial subependymomas are poorly defined. In this study the authors aimed to provide a comprehensive review of all clinical, pathological, radiological, and surgical aspects of this important neoplasm to inform future management strategies. METHODS A systematic review and meta-analysis of MEDLINE, EMBASE, Cochrane, and Google Scholar databases adherent to PRISMA guidelines was conducted. RESULTS Of the 1145 articles initially retrieved, 24 studies encompassing 890 cases were included. The authors identified 3 retrospective cohort studies and 21 case series, but no controlled trials. Mean age at presentation was 46.7 ± 18.1 years with a male predominance (70.2%). Common sites of tumor origin were the lateral ventricle (44.5%) and fourth ventricle (43.1%). Cumulative postoperative mortality and morbidity rates were 3.4% and 24.3% respectively. Meta-analysis revealed that male sex (HR 3.15, 95% CI 1.39-7.14, p = 0.006) was associated with poorer 5-year overall mortality rates. All-cause mortality rates were similar when performing subgroup meta-analyses for age (HR 0.50, 95% CI 0.03-7.36, p = 0.61), smaller subependymoma size (HR 1.51, 95% CI 0.78-2.92, p = 0.22), gross-total resection (HR 0.65, 95% CI 0.35-1.23, p = 0.18), and receipt of postoperative radiation therapy (HR 0.88, 95% CI 0.27-2.88, p = 0.84). Postoperative Karnofsky Performance Index scores improved by a mean difference of 1.62 ± 12.14 points (p = 0.42). The pooled overall 5-year survival rate was 89.2%, while the cumulative recurrence rate was 1.3% over a median follow-up ranging from 15.3 to 120.0 months. The pure subependymoma histopathological subtype was most prevalent (85.6%), followed by the mixed subependymoma-ependymoma tumor variant (13.7%). CONCLUSIONS Surgical extirpation without postoperative radiotherapy results in excellent postoperative survival and functional outcomes in the treatment of intracranial subependymomas. Aggressive tumor behavior should prompt histological reevaluation for a mixed subependymoma-ependymoma subtype. Further high-quality controlled trials are still required to investigate this rare tumor.
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Affiliation(s)
- Barry Ting Sheen Kweh
- 1National Trauma Research Institute, Melbourne.,2Department of Neurosurgery, Royal Melbourne Hospital, Parkville.,3Department of Neurosurgery, The Alfred Hospital, Melbourne; and
| | - Jeffrey Victor Rosenfeld
- 3Department of Neurosurgery, The Alfred Hospital, Melbourne; and.,4Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Martin Hunn
- 3Department of Neurosurgery, The Alfred Hospital, Melbourne; and.,4Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jin Wee Tee
- 1National Trauma Research Institute, Melbourne.,3Department of Neurosurgery, The Alfred Hospital, Melbourne; and.,4Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Lopes OG, Du Pin Almeida FC, Cabral GAPS, Guimaraes RD, da Silva Filho RCM, Landeiro JA. Intraparenchymal subependymoma: Case report and literature review. Surg Neurol Int 2021; 12:154. [PMID: 33948324 PMCID: PMC8088500 DOI: 10.25259/sni_526_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Intracranial subependymomas are rare slow-growing benign tumors typically located in the ventricular system, accounting for 0.07–0.7% of all intracranial neoplasms. Intraparenchymal subependymoma is extremely rare lesions, imposing a challenging diagnosis and management. Case Description: We describe a case of a supratentorial intraparenchymal mass on left occipital lobe in a 26-year-old woman with progressive headache and visual impairment. Differential diagnosis mainly included gliomas, neuronal-glial tumors, ependymoma, and subependymoma. Complete surgical resection was performed and histopathology analysis confirmed diagnosis of subependymoma. Despite its benign behavior the Ki67/MIB-1 labeling index assessed by immunohistochemistry was 5%. After 1 year of follow-up she was free of tumor recurrence. Conclusion: Intraparenchymal subependymoma is extremely rare tumors and literature review showed only 11 cases reported. In general, they are misdiagnosed as other tumors, so careful attention on clinical and radiological features must be taken when looking at a tumor close to the ventricular system, even though it does not have any obvious direct connection to it. Despite its benign nature, total removal must be attempted given that there are reports of recurrence, especially in partially removed tumors with high proliferation index. The role of adjuvant therapy is still limited and new treatment options are being developed as our knowledge on biological and molecular characteristics advances.
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8
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Aftahy AK, Barz M, Krauss P, Liesche F, Wiestler B, Combs SE, Straube C, Meyer B, Gempt J. Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature. BMC Cancer 2020; 20:1060. [PMID: 33143683 PMCID: PMC7640680 DOI: 10.1186/s12885-020-07570-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background Intraventricular neuroepithelial tumors (IVT) are rare lesions and comprise different pathological entities such as ependymomas, subependymomas and central neurocytomas. The treatment of choice is neurosurgical resection, which can be challenging due to their intraventricular location. Different surgical approaches to the ventricles are described. Here we report a large series of IVTs, its postoperative outcome at a single tertiary center and discuss suitable surgical approaches. Methods We performed a retrospective chart review at a single tertiary neurosurgical center between 03/2009–05/2019. We included patients that underwent resection of an IVT emphasizing on surgical approach, extent of resection, clinical outcome and postoperative complications. Results Forty five IVTs were resected from 03/2009 to 05/2019, 13 ependymomas, 21 subependymomas, 10 central neurocytomas and one glioependymal cyst. Median age was 52,5 years with 55.6% (25) male and 44.4% (20) female patients. Gross total resection was achieved in 93.3% (42/45). 84.6% (11/13) of ependymomas, 100% (12/21) of subependymomas, 90% (9/10) of central neurocytomas and one glioependymal cyst were completely removed. Postoperative rate of new neurological deficits was 26.6% (12/45). Postoperative new permanent cranial nerve deficits occurred in one case with 4th ventricle subependymoma and one in 4th ventricle ependymoma. Postoperative KPSS was 90% (IR 80–100). 31.1% of the patients improved in KPSS, 48.9% remained unchanged and 20% declined. Postoperative adverse events rate was 20.0%. Surgery-related mortality was 2.2%. The rate of shunt/cisternostomy-dependent hydrocephalus was 13.3% (6/45). 15.4% of resected ependymomas underwent adjuvant radiotherapy. Mean follow-up was 26,9 (±30.1) months. Conclusion Our surgical findings emphasize satisfactory complete resection throughout all entities. Surgical treatment can remain feasible, if institutional experience is given. Satisfying long-term survival and cure is possible by complete removal. Gross total resection should always be performed under function-remaining aspects due to mostly benign or slow growing nature of IVTs. Further data is needed to evaluate standard of care and alternative therapy options in rare cases of tumor recurrence or in case of patient collective not suitable for operative resection.
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Affiliation(s)
- A Kaywan Aftahy
- Department of Neurosurgery, Technical University Munich, Medical Faculty, School of Medicine, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Melanie Barz
- Department of Neurosurgery, Technical University Munich, Medical Faculty, School of Medicine, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp Krauss
- Department of Neurosurgery, Technical University Munich, Medical Faculty, School of Medicine, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Friederike Liesche
- Department of Neuropathology, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Institute of Pathology, Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.,Department of Radiation Sciences (DRS) Helmholtz Zentrum Munich, Institute of Innovative Radiotherapy (iRT), Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christoph Straube
- Department of Radiation Oncology, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University Munich, Medical Faculty, School of Medicine, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Technical University Munich, Medical Faculty, School of Medicine, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
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Novel Technique of Coregistered Intraoperative Computed Tomography and Preoperative Magnetic Resonance Imaging and Diffusion Tensor Imaging Navigation in Spinal Cord Tumor Resection. Ochsner J 2019; 19:43-48. [PMID: 30983901 DOI: 10.31486/toj.18.0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Intradural spinal tumors are surgically challenging lesions, and intraoperative spinal navigation offers clear potential assistance. While intraoperative computed tomography (iCT) of bony anatomy is routinely performed, coregistration with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) to facilitate intradural spinal tumor resection is not widely described. We present 2 cases in which iCT was coregistered with MRI and DTI for navigational guidance in the resection of intradural spinal tumors to assess technical feasibility and surgical efficacy. Case Series: Navigation using coregistered iCT/MRI was used in the resection of one extramedullary and one intramedullary cervicomedullary tumor. The iCT was obtained following open midline exposure of bony anatomy. The images were then coregistered with preoperative MRI sequences to allow for optical tracking navigation via an optical tracking station (Brainlab). For the intramedullary tumor, preoperative DTI sequences were also coregistered for enhanced identification of relevant anatomy. Navigational accuracy for all cases was confirmed to be acceptable at the level of the posterior bony elements, the dura, and the tumor-parenchyma interface. Conclusion: The coregistration of preoperative MRI sequences and iCT images allowed for meaningfully enhanced navigation during resection. In the case involving the intramedullary cervicomedullary tumor with marked distortion of longitudinal tracts, iCT/DTI navigation allowed for accurate visualization of critical structures and facilitated delineation of tumor margins that otherwise would have been difficult. The use of combined iCT and preoperative MRI/DTI neuronavigational guidance is an effective approach in the resection of intradural extramedullary and intramedullary spinal cord tumors.
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10
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TRPS1 gene alterations in human subependymoma. J Neurooncol 2017; 134:133-138. [DOI: 10.1007/s11060-017-2496-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/14/2017] [Indexed: 11/25/2022]
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11
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Intracranial Subependymoma: A SEER Analysis 2004–2013. World Neurosurg 2017; 101:599-605. [DOI: 10.1016/j.wneu.2017.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 01/05/2023]
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12
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Kong LY, Wei J, Haider AS, Liebelt BD, Ling X, Conrad CA, Fuller GN, Levine NB, Priebe W, Sawaya R, Heimberger AB. Therapeutic targets in subependymoma. J Neuroimmunol 2014; 277:168-75. [PMID: 25465288 DOI: 10.1016/j.jneuroim.2014.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 12/31/2022]
Abstract
Subependymomas are usually treated with surgical resection; however, no standard, defined alternative medical therapy is recommended for patients who are not surgical candidates, owing to a paucity of molecular, immunological, and genetic characterization. To address this, an ex vivo functional analysis of the immune microenvironment in subependymoma was conducted, a subependymoma cytokine/chemokine microarray was constructed for the evaluation of operational immune and molecular pathways, and a subependymoma cell line was derived and used to test a variety of cytotoxic agents that target operational pathways identified in subependymoma. We found that immune effectors are detectable within the microenvironment of subependymoma; however, marked immune suppression is not observed. The subependymoma tissue microarrays demonstrated tumor expression of p53, MDM2, HIF-1α, topoisomerase II-β, p-STAT3, and nucleolin, but not EGFRvIII, EphA2, IL-13RA2, CMV, CTLA-4, FoxP3, PD-1, PD-L1, EGFR, PDGF-α, PDGF-β, PDGFR-α, PDGFR-β, PTEN, IGFBP2, PI3K, MDM4, IDH1, mTOR, or Jak2. A topoisomerase inhibitor (WP744, IC50=0.83 μM) and a p-STAT3/HIF-1α inhibitor (WP1066, IC50=3.15 μM) demonstrated a growth inhibition of the subependymoma cell proliferation. Cumulatively, these data suggest that those agents that interfere with oncogenes operational in subependymoma may have clinical impact.
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Affiliation(s)
- Ling-Yuan Kong
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jun Wei
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Brandon D Liebelt
- Department of Neurosurgery, Houston Methodist, Houston, TX 77030, United States
| | - Xiaoyang Ling
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Charles A Conrad
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Gregory N Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Nicholas B Levine
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Waldemar Priebe
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Raymond Sawaya
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Amy B Heimberger
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
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13
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Noell S, Beschorner R, Bisdas S, Beyer U, Weber RG, Fallier-Becker P, Ritz R. Simultaneous subependymomas in monozygotic female twins: further evidence for a common genetic or developmental disorder background. J Neurosurg 2014; 121:570-5. [DOI: 10.3171/2014.2.jns122179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this paper, a rare case of subependymoma of the fourth ventricle in identical female twins is reported. Magnetic resonance imaging and CT showed nearly identical locations of the tumors in the fourth ventricle and similar growth patterns of the tumors in both sisters. Likewise, postoperative histopathological analysis of both tumors revealed the typical histological appearance of subependymomas. Subependymoma is a rare, low-grade glioma of the CNS, slowly growing and usually asymptomatic. If symptomatic, a subependymoma can in some cases lead to sudden death caused by pressure on the brainstem or decompensated secondary hydrocephalus. This case demonstrates the importance of detecting tumors early and thereby preventing symptoms arising from increasing intracranial pressure, and optimizing therapy options.
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Affiliation(s)
| | | | | | - Ulrike Beyer
- 4Department of Human Genetics, Hannover Medical School, Hannover; and
| | - Ruthild G. Weber
- 4Department of Human Genetics, Hannover Medical School, Hannover; and
| | | | - Rainer Ritz
- 1Departments of Neurosurgery,
- 5Department of Neurosurgery, University of Marburg, Germany
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14
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Hernández-Durán S, Yeh-Hsieh TY, Salazar-Araya C. Pedunculated intraventricular subependymoma: Review of the literature and illustration of classical presentation through a clinical case. Surg Neurol Int 2014; 5:117. [PMID: 25101212 PMCID: PMC4123265 DOI: 10.4103/2152-7806.137837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/23/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Subependymomas are rare benign, noninvasive tumors, classified by the World Health Organization as low grade neoplasms. International data estimate their frequency between 0.2% and 0.7% of the intracranial tumors, and they usually are an incidental finding in autopsies. Preferably located in the fourth ventricle, these tumors tend to become symptomatic when they cause hydrocephalous by obstructing cerebrospinal fluid circulation. CASE PRESENTATION We present the case of a morbidly obese, hypertense, and diabetic patient, who presented with symptoms of gait ataxia, sphincter incontinence, and dysartria in relation to a pedunculated subependymoma in the left lateral ventricle. He underwent a biparietal craniotomy with a microscopic microsurgical approach, through which gross total resection was achieved. No perioperative complications ensued. CONCLUSIONS Given their benign behavior and their excellent response to surgical treatment, subependymomas should be promptly diagnosed and surgically treated to avoid possible neurological damage when they become symptomatic.
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Affiliation(s)
- Silvia Hernández-Durán
- University of Costa Rica, School of Medicine, Ciudad Universitaria Rodrigo Facio, San Pedro de Montes de Oca, Costa Rica
| | - Tze-Yu Yeh-Hsieh
- University of Costa Rica, School of Medicine, Ciudad Universitaria Rodrigo Facio, San Pedro de Montes de Oca, Costa Rica ; Department of Neurological Surgery, Hospital San Juan de Dios, Paseo Colón, Costa Rica
| | - Carlos Salazar-Araya
- University of Costa Rica, School of Medicine, Ciudad Universitaria Rodrigo Facio, San Pedro de Montes de Oca, Costa Rica ; Department of Neurological Surgery, Hospital Dr. Rafael Ángel Calderón Guardia, Calle 17, San José, Costa Rica
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15
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Taif S, Al-Kindi H, Varghese R. A case of septum pellucidum subependymoma with a subtle imaging appearance simulating a cavum septum pellucidum. J Radiol Case Rep 2014; 7:7-16. [PMID: 24421918 DOI: 10.3941/jrcr.v7i10.1561] [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] [Indexed: 11/15/2022] Open
Abstract
Subependymoma is a rare benign slowly growing tumor which usually appears as a well-defined lobulated entirely intraventricular mass, in the fourth or lateral ventricles. We report a case of subependymoma involving the septum pellucidum in a 28 year old female demonstrating a subtle and unusual radiological appearance. It showed very low attenuation on computed tomography, with very high signal on T2- and low signal on T1 weighted magnetic resonance images, merging with the ventricular wall, without definite focal mass. This appearance made the tumor difficult to differentiate from the cerebrospinal fluid and simulating a cavum septum pellucidum. The patient was treated by craniotomy and gross total resection of the mass.
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Affiliation(s)
- Sawsan Taif
- Department of Radiology, khoula hospital, Muscat, Oman
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16
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Landriel F, Besada C, Migliaro M, Christiansen S, Goldschmidt E, Yampolsky C, Ajler P. Atypical hemorrhagic presentation of a fourth ventricle subependymoma: case report. Neurol Med Chir (Tokyo) 2013; 53:828-31. [PMID: 24140775 PMCID: PMC4508720 DOI: 10.2176/nmc.cr2012-0292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To present a case of a fourth ventricle subependymoma (SE) with a spontaneous acute subarachnoid intra-cisternal bleeding. A 33-year-old man was admitted with 5 days history of oppressive occipital headache and neck pain without additional neurological focus. Unenhanced computed tomography (CT) scan demonstrated an isointense mass located in the fourth ventricle with a spontaneously hyperdense acute extratumoral hemorrhage in the cisterna magna. Contrast-enhanced magnetic resonance imaging (MRI) revealed a well-delimitated non-enhanced tumor, hypointense on T1-weighted and hyperintense on T2-weighted images, involving the floor of the fourth ventricle and extending caudally into the cervical spinal canal via foramen magnum. Intraoperative, a large blood clot was removed and a macroscopically hypovascularlesion was completely excised from the right lateral recess and the floor of the fourth ventricle. Intra and postoperative immuno-histopathological examination revealed a SE. The patient has a normal postoperative course and was discharged in the fifth postoperative day. A 10-month postoperative MRI study confirmed a complete tumor resection. Symptomatic SEs should be surgically treated emphasizing the urgency in the presence of hemorrhage. The interest of this case is to demonstrate that infratentorial SEs although extremely rare, might present with acute subarachnoid bleeding.
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17
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Smith AB, Smirniotopoulos JG, Horkanyne-Szakaly I. From the radiologic pathology archives: intraventricular neoplasms: radiologic-pathologic correlation. Radiographics 2013; 33:21-43. [PMID: 23322825 DOI: 10.1148/rg.331125192] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of neoplasms may arise in the ventricular system. Intraventricular neoplasms may be discovered as an incidental finding at cross-sectional imaging or may manifest with varied symptoms depending on their location, including symptoms of increased intracranial pressure. These lesions may arise from various ventricular structures, including the ependymal lining (eg, ependymoma), subependymal layer (eg, subependymoma), or choroid plexus (eg, choroid plexus neoplasms), or they may have a cell of origin that has yet to be determined (eg, chordoid glioma). Other neoplasms involving the ventricular system include central neurocytoma, subependymal giant cell tumor, meningioma, rosette-forming glioneuronal tumor, and metastases. The differential diagnosis for intraventricular neoplasms can be broad, and many of them have similar patterns of signal intensity and contrast enhancement at imaging. However, the location of the lesion in the ventricular system-along with knowledge of the patient's age, gender, and underlying conditions-will help narrow the differential diagnosis.
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Affiliation(s)
- Alice Boyd Smith
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814-4799, USA.
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18
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Abdel-Aal AK, Hamed MF, Al Naief NS, Vattoth S, Bag A. Unusual appearance and presentation of supratentorial subependymoma in an adult patient. J Radiol Case Rep 2013; 6:8-16. [PMID: 23365712 DOI: 10.3941/jrcr.v6i8.999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of a large, heterogeneously enhancing, pathologically proven, supratentorial subependymoma in a 31-year-old male patient presenting with headache, nausea and vomiting as well as gait disturbances. Although most supratentorial subependymomas have distinctive MR features, our case demonstrated imaging findings that made it indistinguishable from other more aggressive malignant supratentorial intraventricular lesions. It is of paramount importance to consider supratentorial subependymomas in the differential diagnosis of supratentorial lesions, even if their radiological features were atypical.
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Affiliation(s)
- Ahmed K Abdel-Aal
- Department of Radiology, University of Alabama at Birmingham (UAB), AL, USA.
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19
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Jain A, Amin AG, Jain P, Burger P, Jallo GI, Lim M, Bettegowda C. Subependymoma: clinical features and surgical outcomes. Neurol Res 2012; 34:677-84. [PMID: 22747714 DOI: 10.1179/1743132812y.0000000064] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Subependymomas are rare, indolent neoplasms that have been described in the brain and the spinal cord. The purpose of this study is to report the clinical and radiolographic features, and surgical outcomes of this entity. METHODS Twenty-six patients with pathologically-verified subependymomas were treated from 1990 through 2009, with a mean follow-up of 39 months. The clinical and radiological records were reviewed and outcomes analyzed. RESULTS There were 15 fourth ventricle tumors, 6 lateral ventricle tumors, and 5 spinal tumors. For the intracranial tumors, headaches, changes in vision, and difficulties with balance were the most common symptoms. Most tumors were heterogeneously enhancing and hypointense or isointense to gray matter on T1-imaging and hyperintense on T2-imaging. All patients with tumors in the fourth ventricle underwent a suboccipital craniotomy and seven patients received an additional C1 laminectomy. Patients with lateral ventricular tumors underwent craniotomy with primarily a transcallosal resection. Patients with spinal tumors underwent laminectomy with intramedullary tumor resection. All tumors were resected employing microsurgical techniques. Overall, six patients had a sub-total resection. No recurrence of tumor or symptoms was noted at last follow-up for any patient, suggesting that maximal safe resection is often sufficient to provide symptomatic relief. Three patients had long-term complications from surgery. Tumor location was not associated with age at presentation, resection achieved, or development of complications. CONCLUSIONS Subependymomas are indolent tumors that when symptomatic can present with cerebrospinal fluid (CSF) obstructive symptoms in the brain and myelopathy in the spinal cord. There is no one symptom diagnostic for subependymomas. Surgical treatment can provide long term tumor control.
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Affiliation(s)
- Amit Jain
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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20
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Peltier J, Lejeune JP, Nicot B, Capel C, Baroncini M, Fichten A, Toussaint P, Desenclos C, Lefranc M, Le Gars D. [Subependymomas of lateral ventricle. Analysis of our series and review of literature]. Neurochirurgie 2011; 57:210-4. [PMID: 22030163 DOI: 10.1016/j.neuchi.2011.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 09/12/2011] [Indexed: 11/18/2022]
Abstract
Subependymoma is a benign lesion, slow-growing neoplasm, representing 0.2 to 0.7 % of intracranial tumors. They are often clinically silent, incidentally discovered at autopsy. These symptoms are related to big volume. They are attached to the septum pellucidum, leading to hydrocephalus by Monro foramen obstruction. Overall mean age at diagnosis is 39 years with more males than females. At CT-scan, subependymoma shows a slightly low attenuation compared to gray matter. There is no or mild enhancement following contrast injection. On MR T1-weighted imaging, subependymoma is isointense and hyperintense on MR T2-weighted imaging. Intramural calcifications and cystic components are noted in 20 to 30 % of patients. Peritumoral oedema is absent. Immunohistochemicals studies show intense positivity for S-100 and GFAP. The treatment is surgical with an excellent prognosis.
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Affiliation(s)
- J Peltier
- Service de neurochirurgie, hôpital Nord, CHU d'Amiens, place Victor-Pachet, 80054 Amiens cedex 1, France.
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21
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Surgical management of intracranial subependymomas. Acta Neurochir (Wien) 2011; 153:1469-75. [PMID: 21499782 DOI: 10.1007/s00701-011-1007-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 03/24/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intracranial subependymomas are rare, slow-growing and usually non-invasive tumors. The aim of this study was to analyze our experience with the surgical treatment of intracranial subependymomas. METHODS Between 1991 and 2007, 11 patients with intracranial subependymomas had surgery in our institution. Mean age of the patients was 54.4 years (ranging from 40 to 85 years). RESULTS Tumors were located in the fourth ventricle in seven patients and in the lateral ventricle in four patients. Most patients presented with symptoms related to intracranial hypertension and/or cerebellar signs and symptoms (headache: eight patients; dizziness: six patients; nausea: six patients; gait ataxia: four patients), one patient with cognitive decline and flattened affect, and one patient with a hemiparesis. Six patients presented with hydrocephalus, but only one needed a permanent cerebrospinal fluid (CSF) shunt. Complete removal of the tumor was possible in eight cases. Following surgery, only one patient experienced a permanent drop of his Karnofsky Performance Index (from 70 to 60). Median follow-up was 37 months. There were no true recurrences during follow-up. A second surgery was required 7 years after the first operation for progression of an incompletely resected tumor. CONCLUSIONS Removal of symptomatic subependymomas can be performed safely. Prognosis is excellent after a complete resection. The potential for a surgical cure, low surgical complication rates and the risk of undertreatment of a more aggressive tumor together may justify surgery for asymptomatic lesions.
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22
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Cunha AM, Brito ACG, de Almeida Lima G, de Souza LA, Simões EL, Telles C, Montagna N. Cerebellopontine angle subependymoma without fourth ventricle extension: an uncommon tumor in a rare location. Neuropathology 2011; 32:164-70. [PMID: 21692863 DOI: 10.1111/j.1440-1789.2011.01233.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Subependymomas are benign tumors that occur predominantly in the ventricular system. We describe a case of a 57-year-old man with a large cerebellopontine angle (CPA) tumor which expanded into the jugular foramen. Complete surgical excision of the tumor was achieved through a retrosigmoid approach and the histopathological diagnosis was subependymoma. Subependymomas located exclusively in the CPA without extension into the fourth ventricle are extremely rare. The mainly pathological features and the difficulty in correctly diagnosing these cases preoperatively, even with MRI, are discussed.
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Affiliation(s)
- Alexandre Martins Cunha
- Division of Neurosurgery, Department of Surgical Specialties, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Brazil.
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23
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Maekawa M, Fujisawa H, Iwayama Y, Tamase A, Toyota T, Osumi N, Yoshikawa T. Giant subependymoma developed in a patient with aniridia: analyses of PAX6 and tumor-relevant genes. Brain Pathol 2011; 20:1033-41. [PMID: 20500513 PMCID: PMC2991767 DOI: 10.1111/j.1750-3639.2010.00406.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We observed an unusually large subependymoma in a female patient with congenital aniridia. To analyze the genetic mechanisms of tumorigenesis, we first examined the paired box 6 (PAX6) gene using both tumor tissue and peripheral lymphocytes. Tumor suppressor activity has been proposed for PAX6 in gliomas, in addition to its well‐known role in the eye development. Using genomic quantitative PCR and loss of heterozygosity analysis, we identified hemizygous deletions in the 5′‐region of PAX6. In lymphocytes, the deletion within PAX6 spanned from between exons 6 and 7 to the 5′‐upstream region of the gene, but did not reach the upstream gene, RNC1, which is reported to be associated with tumors. The subependymoma had an additional de novo deletion spanning from the intron 4 to intron 6 of PAX6, although we could not completely determine whether these two deletions are on the same chromosome or not. We also examined other potentially relevant tumor suppressor genes: PTEN, TP53 and SOX2. However, we detected no exonic mutations or deletions in these genes. Collectively, we speculate that the defect in PAX6 may have contributed to the extremely large size of the subependymoma, due to a loss of tumor suppressor activity in glial cell lineage.
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Affiliation(s)
- Motoko Maekawa
- Laboratory for Molecular Psychiatry, RIKEN Brain Science Institute, Wako-city, Saitama, Japan.
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24
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Akamatsu Y, Utsunomiya A, Suzuki S, Endo T, Suzuki I, Nishimura S, Ezura M, Suzuki H, Uenohara H, Tominaga T. Subependymoma in the lateral ventricle manifesting as intraventricular hemorrhage. Neurol Med Chir (Tokyo) 2010; 50:1020-3. [PMID: 21123990 DOI: 10.2176/nmc.50.1020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 32-year-old man presented with subependymoma in the lateral ventricle causing intraventricular hemorrhage and manifesting as severe headache and disturbance of consciousness. Computed tomography on admission showed a massive intraventricular hemorrhage and acute obstructive hydrocephalus. Cerebral angiography revealed no abnormal findings. Emergency external ventricular drainage was performed, and his neurological deficits gradually improved. Magnetic resonance imaging at 5 weeks after admission showed a tumor arising from the septum pellucidum or the floor of the right lateral ventricle, appearing as a mixed-intensity solid tumor, which was partially enhanced following gadolinium administration. The tumor had arisen from the septum pellucidum and was totally removed via an interhemispheric anterior transcallosal approach. Histological examination found typical subependymoma, with little vascularity. Intraventricular hemorrhage from cerebral neoplasms is usually due to highly vascular tumors. Since subependymomas are quite benign and show poor vascularity, intraventricular or subarachnoid hemorrhages are very rare, but do occasionally occur.
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Affiliation(s)
- Yousuke Akamatsu
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
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25
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Fujisawa H, Hasegawa M, Ueno M. Clinical features and management of five patients with supratentorial subependymoma. J Clin Neurosci 2010; 17:201-4. [DOI: 10.1016/j.jocn.2009.05.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 05/14/2009] [Accepted: 05/17/2009] [Indexed: 11/29/2022]
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Abstract
Overexpression of Aurora B kinase, which regulates cell progression through mitosis and cytokinesis, has been shown to be associated with higher-grade tumors and shortened survival in astrocytomas. Aurora B expression was evaluated by immunohistochemistry in 32 ependymomas, 10 anaplastic ependymomas, 16 myxopapillary ependymomas, and 9 subependymomas. Aurora B expression was identified in 20 (62.5%) ependymomas, 5 (50%) anaplastic ependymomas, 1 (6.3%) myxopapillary ependymoma, and no subependymomas. The association between Aurora B expression and World Health Organization grade II/III tumors was statistically significant (P<0.0001). There was no difference in the level of Aurora B expression between ependymomas and anaplastic ependymomas. Aurora B expression was not associated with patient age, sex, tumor location, tumor recurrence, or death from tumor. In contrast to astrocytomas, elevated Aurora B expression in higher-grade ependymomas does not seem to correlate with clinical course, although it may be a potential target of Aurora kinase inhibitors.
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27
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Kurian KM, Jones DTW, Marsden F, Openshaw SWS, Pearson DM, Ichimura K, Collins VP. Genome-wide analysis of subependymomas shows underlying chromosomal copy number changes involving chromosomes 6, 7, 8 and 14 in a proportion of cases. Brain Pathol 2008; 18:469-73. [PMID: 18397339 PMCID: PMC2659379 DOI: 10.1111/j.1750-3639.2008.00148.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Subependymomas (SE) are slow-growing brain tumors that tend to occur within the ventricles of middle-aged and elderly adults. The World Health Organization classifies these tumors within the ependymoma group. Previous limited analysis of this tumor type had not revealed significant underlying cytogenetic abnormalities. We have used microarray comparative genomic hybridization to study a series of SE (n = 12). A whole-genome array at 0.97-Mb resolution showed copy number abnormalities in five of 12 cases (42%). Two cases (17%) showed regions of loss on chromosome 6. More detailed analysis of all cases using a chromosome 6 tile-path array confirmed the presence of overlapping regions of loss in only these two cases. One of these cases also showed trisomy chromosome 7. Monosomy of chromosome 8 was seen in a further two cases (17%), and a partial loss on chromosome 14 was observed in one additional case. This is the first array-based, genome-wide study of SE. The observation that five of 12 cases examined (42%) at 0.97-Mb resolution showed chromosomal copy number abnormalities is a novel finding in this tumor type.
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Affiliation(s)
- Kathreena M Kurian
- Department of Pathology, Division of Molecular Histopathology, Cambridge University, Cambridge, UK.
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28
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Rushing EJ, Cooper PB, Quezado M, Begnami M, Crespo A, Smirniotopoulos JG, Ecklund J, Olsen C, Santi M. Subependymoma revisited: clinicopathological evaluation of 83 cases. J Neurooncol 2007; 85:297-305. [PMID: 17569000 DOI: 10.1007/s11060-007-9411-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 05/03/2007] [Indexed: 12/16/2022]
Abstract
OBJECT Subependymomas are rare ependymal neoplasms. To date, a large clinicopathologic study of these benign neoplasms treated with modern neurosurgical techniques has not been reported. METHODS Eighty-three cases of subependymoma were retrieved from the files of the Armed Forces Institute of Pathology. Clinicopathological features were reviewed; chromogenic in situ hybridization analysis for chromosome 22 was performed (n = 8), and patient follow-up was obtained (n = 34). Overall, the patients included 68 males and 15 females, 1.5 to 85 years of age (mean, 51.0 years). Twenty-seven cases were discovered at autopsy and the remaining were surgical specimens (n = 56). Tumors arose in the posterior fossa (n = 43), lateral ventricles (n = 37), spinal cord (2) and only one arose in the temporal horn. Tumors ranged in size from 2.0 mm to 60 mm in greatest dimension (mean, 23.0 mm). Eighteen-percent (15/83) of subependymomas exhibited a mixed histologic pattern; that is, subependymoma together with another glial tumor. The most common mixture (13/15) was subependymoma and ependymoma. Surgical excision was used in all symptomatic patients; 10 patients received radiation. Four patients developed a recurrence due to incomplete excision. All patients were without evidence of disease at the last follow-up: alive (n = 28) or dead (n = 8). CONCLUSIONS Age is the only variable found to be significantly associated with survival. Currently, surgical methods result in an excellent long-term clinical outcome. Subependymomas do not appear to be associated with NF2 mutations.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Cerebral Ventricle Neoplasms/complications
- Cerebral Ventricle Neoplasms/mortality
- Cerebral Ventricle Neoplasms/pathology
- Cerebral Ventricle Neoplasms/surgery
- Child
- Child, Preschool
- Cohort Studies
- Ependymoma/complications
- Ependymoma/mortality
- Ependymoma/pathology
- Ependymoma/surgery
- Female
- Glioma, Subependymal/complications
- Glioma, Subependymal/mortality
- Glioma, Subependymal/pathology
- Glioma, Subependymal/surgery
- Humans
- Hydrocephalus/etiology
- Hydrocephalus/pathology
- Infant
- Infratentorial Neoplasms/complications
- Infratentorial Neoplasms/mortality
- Infratentorial Neoplasms/pathology
- Infratentorial Neoplasms/surgery
- Lateral Ventricles/pathology
- Male
- Middle Aged
- Mixed Tumor, Malignant/complications
- Mixed Tumor, Malignant/mortality
- Mixed Tumor, Malignant/pathology
- Mixed Tumor, Malignant/surgery
- Retrospective Studies
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Elisabeth J Rushing
- Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
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29
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Gilhuis HJ, van der Laak JAWM, Pomp J, Kappelle AC, Gijtenbeek JMM, Wesseling P. Three-dimensional (3D) reconstruction and quantitative analysis of the microvasculature in medulloblastoma and ependymoma subtypes. Angiogenesis 2006; 9:201-8. [PMID: 17109194 DOI: 10.1007/s10456-006-9054-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 09/05/2006] [Indexed: 11/29/2022]
Abstract
In the World Health Organisation (WHO) classification of tumours of the nervous system, four main histopathological subtypes of medulloblastomas (classic medulloblastoma, desmoplastic medulloblastoma, medulloblastoma with extensive nodularity and advanced neuronal differentiation and large cell/anaplastic medulloblastoma) as well as of ependymal tumours (low-grade ependymoma, anaplastic ependymoma, myxopapillary ependymoma and subependymoma) are recognised. Under the hypothesis that the microvascular architecture of tumours is a reflection of the histopathological subtype, we performed three-dimensional reconstructions of the microvasculature in these subtypes of medulloblastomas and ependymal tumours using computerised image analysis. In addition, we quantitatively assessed three microvascular parameters (number, area, perimeter) in these neoplasms. Three-dimensional reconstructions showed a dense pattern of irregular vessels in classic and large cell medulloblastoma. In desmoplastic medulloblastoma and medulloblastoma with extensive nodularity, the vessels were more unevenly distributed and organised around the nodular areas. Classic medulloblastoma and large cell medulloblastoma had on average the largest vessel area and perimeter. The highest number of vessels was seen in classic medulloblastoma and medulloblastoma with extensive nodularity. Three-dimensional analysis of ependymal tumours showed that low-grade ependymoma had larger but fewer vessels compared to anaplastic ependymoma, while myxopapillary ependymoma had a complex, heterogeneous pattern of vessels and subependymoma few but regular vessels. In ependymal tumours, the highest values for vessel number, vessel area and vessel perimeter were found in anaplastic ependymoma and the lowest values in subependymoma. We conclude that our three-dimensional reconstructions shed unprecedented light on the tumour vasculature in medulloblastomas and ependymal tumours and expect that such reconstructions are helpful tools for further studies on tumour angiogenesis.
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Affiliation(s)
- H Jacobus Gilhuis
- Department of Neurology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Ragel BT, Osborn AG, Whang K, Townsend JJ, Jensen RL, Couldwell WT. Subependymomas: An analysis of Clinical and Imaging Features. Neurosurgery 2006; 58:881-90; discussion 881-90. [PMID: 16639322 DOI: 10.1227/01.neu.0000209928.04532.09] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractOBJECTIVE:Subependymomas are slow-growing, benign tumors usually found incidentally in the fourth ventricle at autopsy. They are typically associated with the ventricular system and become apparent clinically only when symptoms of hydrocephalus or mass effect develop. We review clinical, histological, and contemporary radiographic presentations of 16 subependymomas, including 2 intraparenchymal tumors.METHODS:We retrospectively evaluated eight patients with pathologically proven subependymomas. Initial magnetic resonance imaging and magnetic resonance spectroscopy were reviewed when available. Imaging was also available on eight outside subependymoma cases reviewed by our radiology department.RESULTS:Twelve of these subependymomas were intraventricular, one was in the posterior fossa, two were intraparenchymal, and one was an intramedullary spinal cord tumor. These lesions were hypo- to hyperintense on T1- and T2-weighted magnetic resonance imaging, with minimal to moderate enhancement. Initial complaints included headache, seizures, tingling sensations, and weakness. Among our eight patients who underwent gross total resection with no adjuvant therapy, no recurrences have been noted on follow-up magnetic resonance imaging.CONCLUSION:Subependymomas are rare, representing only 0.51% of all central nervous system tumors operated on during an 8-year period at the University of Utah. Clinical symptoms were associated with tumor location: intracranial masses caused headaches, seizures, and neurological complaints, and spinal cord locations resulted in neurological deficit. The authors review the clinical presentation, management, and contemporary radiographic appearance of this rare tumor.
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Affiliation(s)
- Brian T Ragel
- Department of Neurosurgery, University of Utah, and Huntsman Cancer Institute, Salt Lake City 84132, USA
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You H, Kim YI, Im SY, Suh-Kim H, Paek SH, Park SH, Kim DG, Jung HW. Immunohistochemical study of central neurocytoma, subependymoma, and subependymal giant cell astrocytoma. J Neurooncol 2005; 74:1-8. [PMID: 16078101 DOI: 10.1007/s11060-004-2354-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
For investigation of histogenesis of central neurocytomas (CNs), subependymoma (SEs), subependymal giant cell astrocytomas (SEGAs), we studied expression of various neuronal and glial biomarkers by immunohistochemical (IHC) study and reverse transcriptase-polymerase chain reaction (RT-PCR). The materials for IHC were paraffin section of seven CNs, three SEs, and eight SEGAs and those for RT-PCR were frozen tissues of seven CNs, three SEs, and five SEGAs. Control group was five ependymomas (EPs) and four pilocytic astrocytomas (PAs). The neuronal biomarkers included nestin, chromogranin A (chrA), synaptophysin (SNP), neuronal cell adhesion molecule (NCAM), neuron specific enolase (NSE), neuronal nuclear antigen (NeuN), neurofilament (NF) and the glial marker was GFAP. CNs expressed all neuronal markers except NF (0%), SNP (100%), NCAM (100%), NSE (100%), NeuN (100%), nestin (29%) and chrA (43%), but GFAP expression was found only in one case (14%). SEGA coexpressed several neuronal markers and a glial marker; NeuN (100%), NSE (88%), NCAM (63%), nestin (100%), SNP (weakly and focally, 100%), and GFAP (100%), however, other neuronal markers including chrA, SNP and NF were all negative. SE expressed nonspecific neuronal markers (NCAM (100%) and NSE (100%)) which showed weak intensity and a GFAP (100%), but not nestin. Among control cases of EPs and PAs, no one case expressed neuronal markers except nonspecific neuronal marker of NCAM, but robustly expressed GFAP. RT-PCR product of nestin was expressed in 29% of CNs (2/7cases), 60% of SEGAs (3/5 cases), 100% of SEs (3/3 cases), 80% of EPs (4/5 cases), and 25% of PAs (1/4 cases). Conclusively, coexpression of neuronal and glial markers and expression of nestin in CNs, SEGAs and SEs suggested the origin of these tumor cells might be the stem cells being able to differentiate into both neuronal and glial phenotypes. But CNs might be originated from rather neuronally committed stem cells and SEs from rather glially committed stem cells.
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Affiliation(s)
- Heon You
- Neuro-Oncology Clinic, Center for Specific Organ Center, National Cancer, Seoul, Korea
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Rath TJ, Sundgren PC, Brahma B, Lieberman AP, Chandler WF, Gebarski SS. Massive symptomatic subependymoma of the lateral ventricles: case report and review of the literature. Neuroradiology 2005; 47:183-8. [PMID: 15702322 DOI: 10.1007/s00234-005-1342-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Accepted: 12/14/2004] [Indexed: 10/25/2022]
Abstract
Subependymomas are benign intraventricular tumors with an indolent growth pattern, which are usually asymptomatic, and most commonly occur in the fourth and lateral ventricles. When symptomatic, subependymomas often obstruct critical portions of the cerebrospinal fluid (CSF) pathway, causing hydrocephalus, and range from 3 cm to 5 cm in size. We report a case of an unusually massive subependymoma of the lateral ventricles treated with subtotal resection, ventriculoperitoneal shunt, and post-surgical radiation. The clinical course, radiographic and pathologic characteristics of this massive intraventricular subependymoma are discussed, as well as the differential diagnosis of lateral ventricular masses and a review of the literature concerning subependymomas.
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Affiliation(s)
- T J Rath
- Department of Radiology, University of Michigan Health Systems, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0030, USA
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Kawaguchi T, Kumabe T, Shimizu H, Watanabe M, Tominaga T. 201Tl-SPECT and 1H-MRS study of benign lateral ventricle tumors: differential diagnosis of subependymoma. Neurosurg Rev 2004; 28:96-103. [PMID: 15580370 DOI: 10.1007/s10143-004-0353-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 08/13/2004] [Indexed: 11/27/2022]
Abstract
The introduction of computed tomography (CT) and magnetic resonance (MR) imaging has resulted in the detection of increasing numbers of asymptomatic intraventricular tumors. Establishing the correct preoperative diagnosis is important to prevent unnecessary surgical intervention. Our study includes nine cases of benign lateral ventricle tumors including two cases of central neurocytoma, two of subependymal giant cell astrocytoma, two of pilocytic astrocytoma and three of subependymoma treated surgically between 1996 and 2003. MR imaging, proton MR spectroscopy ((1)H-MRS) and thallium-201 single photon emission computed tomography ((201)Tl-SPECT) were performed in all patients. All three types of tumor demonstrated heterogeneous enhancement on MR imaging with gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) and increased choline (Cho) peak and decreased N-acetyl aspartate (NAA) and creatine (Cre) peaks on (1)H-MRS. (201)Tl-SPECT showed high uptake of (201)Tl without wash out in all cases of central neurocytoma, subependymal giant cell astrocytoma and pilocytic astrocytoma, but no uptake in cases of subependymoma. Absence of (201)Tl uptake in contrast with enhancement on MR imaging and the (1)H-MRS features of modest elevation of the Cho/Cre ratio, reduction of the NAA peak and presence of lactate/lipid peaks are characteristic features of subependymomas and useful to establish a preoperative diagnosis.
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Affiliation(s)
- Tomohiro Kawaguchi
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract
Ependymomas are uncommon neoplasms of the central nervous system (CNS), and as a consequence, few randomized, clinical trials have been performed, thereby limiting treatment guidelines. A review of the literature would permit the following conclusions regarding treatment. The best management of newly diagnosed ependymoma entails a complete resection corroborated by postoperative contrast-enhanced magnetic resonance imaging (MRI). If an incomplete resection is documented, a second attempt at gross total resection should be considered, given the prognostic significance of complete resection. Small volume residual disease is best managed with involved-field radiotherapy unless postoperative staging (cerebrospinal fluid cytology, neuraxis MRI) documents metastatic disease, which is best managed by craniospinal irradiation. The role of chemotherapy is uncertain and in general would be reserved for patients having previously failed surgery and radiotherapy. Disease-free survival following recurrence is unusual (<15% at 5 years) and suggests intensification of initial adjuvant treatment may best prevent relapse.
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Affiliation(s)
- Marc C Chamberlain
- Department of Neurology, USC/Norris Cancer Center, 1441 Eastlake Avenue, Suite 3459, Los Angeles, CA 90033-0804, USA.
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Seol HJ, Hwang SK, Choi YL, Chi JG, Jung HW. A case of recurrent subependymoma with subependymal seeding: case report. J Neurooncol 2003; 62:315-20. [PMID: 12777084 DOI: 10.1023/a:1023357810796] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Subependymoma is a rare, slow growing, rarely recurrent tumor. We report a case of re current subependymoma with subependymal seeding. An intraventricular tumor in the left temporal horn was detected in a 48-year-old female who presented with a 4-year history of dizziness and memory disturbance. Following near total surgical resection, a tumor diagnosis of subependymoma was confirmed by scattered clusters of isomorphic nuclei embedded in a dense fibrillary matrix of glial cell processes. Twenty-six months after surgery, follow-up (F/U) magnetic resonance (MR) imaging revealed tumor recurrence in the previous site which necessitated linear accelerator radiosurgery (LINAC). A further 21 months later, F/U MR imaging showed recurrent, multiple, enhanced, nodular lesions in the enlarged left lateral ventricle for which the patient underwent reoperation. Radiological and operative findings revealed local relapse with subependymal seeding. The pathological finding was similar to that of the previous tumor and compatible with subependymoma. The patient underwent radiation therapy for the residual tumor. This case history suggests that symptomatic residual tumors require close observation even though the clinical course of subependymoma is usually benign.
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Affiliation(s)
- Ho Jun Seol
- Department of Neurosurgery, Seoul National University College Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Im SH, Paek SH, Choi YL, Chi JG, Kim DG, Jung HW, Cho BK. Clinicopathological study of seven cases of symptomatic supratentorial subependymoma. J Neurooncol 2003; 61:57-67. [PMID: 12587796 DOI: 10.1023/a:1021204616334] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Subependymomas are rare, slow-growing tumors, the majority of which are found incidentally at postmortem examination. The authors retrospectively analyzed seven cases of symptomatic supratentorial subependymomas. Five were females and two were males, ranging in age at operation of 6-50 years (median 45). The follow-up period ranged from 1.5 to 8.3 years. Tumors were intraventricularly located as a lobulated mass with cystic changes: four in the frontal horn, two in the trigone, and one in the third ventricle. Moderate to marked enhancement was noted in two tumors of the trigone and in one tumor of the frontal horn on both CT scan and MR imaging. MR spectroscopy of a recurrent subependymoma demonstrated a higher Cho/Cr ratio of 2.66, compared with a Cho/Cr ratio (0.48) of a non-recurrent subependymoma. Angiography, which was performed in four patients, revealed no staining in two and delayed modest staining in two. Radiosurgery was performed in two patients but was ineffective. Five patients with gross total tumor resection showed no evidence of tumor recurrence to the last follow-up. The two subtotally resected trigonal tumors progressed two years after operation. No histological difference except MIB-1 index was noted between recurrent and non-recurrent cases. In conclusion, we suggest that subependymoma could show progressive biological behavior, especially in cases of markedly enhancing, irregularly contoured, large tumors located in the trigone. For symptomatic supratentorial subependymomas, gross total resection is the treatment of choice and radiation has little effect on tumor control.
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Affiliation(s)
- So-Hyang Im
- Department of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Perunovic B, McCarthy KP, Moss TH. Subependymoma adjacent to a complex tail bud malformation: more than just a coincidence? Neuropathol Appl Neurobiol 2000; 26:487-9. [PMID: 11054191 DOI: 10.1046/j.1365-2990.2000.00266-1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mineura K, Shioya H, Kowada M, Ogawa T, Hatazawa J, Uemura K. Subependymoma of the septum pellucidum: characterization by PET. J Neurooncol 1997; 32:143-7. [PMID: 9120543 DOI: 10.1023/a:1005784020134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report the evaluation of a subependymoma of the septum pellucidum by positron emission tomography (PET) with analysis of 18F-fluorodeoxyglucose (FDG) kinetics. The tumor showed exceedingly low rates of glucose metabolism (rCMRG1) and kinetic constants (K1, K2, and K3). This hypometabolism indicates low cellular density and slow growth.
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Affiliation(s)
- K Mineura
- Neurosurgical Service, Akita University Hospital, Japan
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Maiuri F, Gangemi M, Iaconetta G, Signorelli F, Del Basso De Caro M. Symptomatic subependymomas of the lateral ventricles. Report of eight cases. Clin Neurol Neurosurg 1997; 99:17-22. [PMID: 9107462 DOI: 10.1016/s0303-8467(96)00554-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Subependymomas are rare, slow-growing, benign intraventricular tumors, which often are asymptomatic and are discovered incidentally. The review of the literature shows more than 100 symptomatic cases, less than half located in the lateral ventricles. Here we report 8 cases of symptomatic subependymomas of the lateral ventricles, studied by CT and/or MR and treated by direct surgical approach. The suspicion of a subependymoma should arise when a patient older than 10-15 years with long clinical history presents an intraventricular tumor isodense on CT and isointense in T1 and hyperintense in T2 on MR, with scarce or discrete contrast enhancement. Surgical treatment is indicated in symptomatic subependymomas of the lateral ventricles and usually allows complete tumor removal. The prognosis is usually good, also without postoperative irradiation.
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Affiliation(s)
- F Maiuri
- Department of Neurosurgery, School of Medicine, University Federico II, Naples, Italy
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Abstract
Subependymomas are unusual tumors believed to arise from the bipotential subependymal cell. Previous reports of familial occurrence of subependymoma have involved monozygous twins and siblings. The authors describe the first reported occurrence of fourth ventricular subependymoma in a father and son, suggesting the possibility of direct inheritance.
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Affiliation(s)
- T C Ryken
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City
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Cheng TM, Coffey RJ, Gelber BR, Scheithauer BW. Simultaneous presentation of symptomatic subependymomas in siblings: case reports and review. Neurosurgery 1993; 33:145-50. [PMID: 8355833 DOI: 10.1227/00006123-199307000-00025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Two young adult siblings independently developed similar neurological complaints that included headaches, photophobia, nausea, and intermittent lancinating facial pains. Magnetic resonance imaging revealed fourth ventricular lesions that required surgery in both patients. A pathological review revealed subependymomas with virtually identical histological features. The clinical features and common pathological findings of both patients suggest that familial subependymomas may have a maldevelopmental origin with genetic implications.
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Affiliation(s)
- T M Cheng
- Department of Neurologic Surgery, Mayo Clinic, Mayo Medical School, Rochester, Minnesota
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