Fourth Ventricular Lesions in Metastatic Gliomas: A Rare Predilection?

Khan, Mohammed Nazir; Poulin, A.; Essig, M.

doi:10.14791/btrt.2017.5.1.24

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…These recurrent patterns imply leptomeningeal dissemination (LMD) as the pathogenesis of ITR. Previous studies have reported that supratentorial GBM cells metastasize into the fourth ventricle or cerebellum via the cerebrospinal fluid (CSF) through an aqueduct from the third or lateral ventricle [ 5 , 14 ]. Moreover, tumor cells may disseminate through the CSF with a predilection to regions with slow CSF flow or gravity-dependent sites, such as the basal cisterns or posterior fossa [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and prognosis of Glioblastoma patients with infratentorial recurrence

Kawauchi¹,

Ohno²,

Honda‐Kitahara³

et al. 2023

BMC Neurol

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Background Glioblastoma (GBM) infrequently recurs in the infratentorial region. Such Infratentorial recurrence (ITR) has some clinically unique characteristics, such as presenting unspecific symptoms and providing patients a chance to receive additional radiotherapy. However, the clinical significances of ITR are not well studied. Methods We reviewed newly diagnosed isocitrate dehydrogenase (IDH)-wildtype GBM patients treated at our institution between October 2008 and December 2018. ITR was defined as any type of recurrence in GBM, including dissemination or distant recurrence, which primarily developed in the supratentorial region and recurred in the infratentorial region. Results Of 134 patients with newly diagnosed IDH-wildtype GBM, six (4.5%) were classified as having ITR. There was no significant difference in median duration from the first surgery to ITR development between patients with and without ITR (12.2 vs. 10.2 months, P = 0.65). The primary symptoms of ITR were gait disturbance (100%, n = 6), dizziness (50.0%, n = 3), nausea (33.3%, n = 2), and cerebellar mutism (16.7%, n = 1). In four cases (66.7%), symptoms were presented before ITR development. All patients received additional treatments for ITR. The median post-recurrence survival (PRS) of ITR patients was significantly shorter than that of general GBM patients (5.5 vs. 9.1 months, P = 0.023). However, chemoradiotherapy contributed to palliating symptoms such as nausea. Conclusions ITR is a severe recurrence type in GBM patients. Its symptoms are neurologically unspecific and can be overlooked or misdiagnosed as side effects of treatments. Carefully checking the infratentorial region, especially around the fourth ventricle, is essential during the GBM patient follow-up.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and prognosis of Glioblastoma patients with infratentorial recurrence

Kawauchi¹,

Ohno²,

Honda‐Kitahara³

et al. 2023

BMC Neurol

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“…There still lacks efficient and effective treatment modalities for GBM dissemination control. Some polite studies revealed that stereotactic radiosurgery (SRS) might be helpful for a single, small lesion with the satisfactory disease control (19,47). For eligible patients, SRS might be an ideal choice to alleviate suffering and prolong survival.…”

Section: Discussionmentioning

confidence: 99%

T2/FLAIR Abnormity Could be the Sign of Glioblastoma Dissemination

Huang

Chen

et al. 2022

Front. Neurol.

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PurposeNewly emerged or constantly enlarged contrast-enhancing (CE) lesions were the necessary signs for the diagnosis of glioblastoma (GBM) progression. This study aimed to investigate whether the T2-weighted-Fluid-Attenuated Inversion Recovery (T2/FLAIR) abnormal transformation could predict and assess progression for GBMs, especially for tumor dissemination.MethodsA consecutive cohort of 246 GBM patients with regular follow-up and sufficient radiological data was included in this study. The series of T2/FLAIR and T1CE images were retrospectively reviewed. The patients were separated into T2/FLAIR and T1CE discordant and accordant subgroups based on the initial progression images.ResultsA total of 170 qualified patients were finally analyzed. The incidence of discordant T2/FLAIR and T1CE images was 25.9% (44/170). The median time-span of T2/FLAIR indicated tumor progression was 119.5 days (ranging from 57 days-unreached) prior to T1CE. Nearly half of patients (20/44, 45.5%) in the discordant subgroup suffered from tumor dissemination, substantially higher than accordant patients (23/126, 20.6%, p < 0.001). The median time to progression (TTP), post-progression survival (PPS), and overall survival (OS) were not statistically different (all p > 0.05) between discordant and accordant patients.ConclusionsT2/FLAIR abnormity could be the sign of GBM progression, especially for newly emerged lesions disseminating from the primary cavity. Physicians should cast more attention on the dynamic change of T2/FLAIR images, which might be of great significance for progression assessment and subsequent clinical decision-making.

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“…There still lacks e cient and effective treatment modalities for GBM dissemination control. Some polite studies revealed stereotactic radiosurgery (SRS) might be helpful for a single, small lesion with satisfactory disease control 17,45 . For eligible patients, SRS might be an ideal choice to alleviate suffering and prolong survival.…”

Section: Discussionmentioning

confidence: 99%

T2/FLAIR Abnormity Could Be the Early Sign of Glioblastoma Dissemination

Li¹,

Huang²,

Chen³

et al. 2021

Preprint

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PurposeNewly emerged or constantly enlarged contrast-enhancing (CE) instead of T2/FLAIR lesions were the necessary sign for the diagnosis of glioblastoma (GBM) progression. This study aimed to investigate whether the T2/FLAIR abnormal transformation could predict and assess progression for GBMs, especially for dissemination. MethodsA consecutive cohort of 246 de novo GBM with regular follow-up and sufficient radiological data were included in this study. The series of T2/FLAIR, T1CE images were retrospectively reviewed. The patients were separated into T2/FLAIR and T1CE discordant and accordant subgroups based on the initial progression images.ResultsA total of 170 qualified patients were finally analyzed. The incidence of discordant T2/FLAIR and T1CE images was 25.9% (44/170). The median time of T2/FLAIR indicated tumor progression was 119.5 days (ranging from 57 days-unreached) prior to T1CE. Nearly half of patients (20/44, 45.5%) in discordant subgroup suffered from tumor dissemination, substantially higher than accordant patients (23/126, 20.6%, P<0.001). The median time to progression (TTP), post-progression survival (PPS), and overall survival (OS) were not statistically different (all P>0.05) between discordant and accordant patients. Conclusions T2/FLAIR abnormity could be the early sign of GBM progression, especially for newly emerged lesions disseminated from the primary cavity. Physicians should cast more attention on the dynamic change of T2/FLAIR images for progression assessment and subsequent clinical decision-making.

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Fourth Ventricular Lesions in Metastatic Gliomas: A Rare Predilection?

Cited by 6 publications

References 12 publications

Clinical characteristics and prognosis of Glioblastoma patients with infratentorial recurrence

Clinical characteristics and prognosis of Glioblastoma patients with infratentorial recurrence

T2/FLAIR Abnormity Could be the Sign of Glioblastoma Dissemination

T2/FLAIR Abnormity Could Be the Early Sign of Glioblastoma Dissemination

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