Transcortical approach to lateral ventricular central neurocytomas: a case series and review of the literature

Abstract

Background: Central neurocytomas (CN) are relatively rare intrinsic brain tumors of an ectodermal origin that usually arise in the lateral ventricles close to the foramen of Monro and septum pellucidum. Surgical gross total resection is now considered the gold standard treatment for CNs. The choice of the most convenient approach (transcortical or transcallosal) remains controversial. This study was designed to assess the efficiency and safety of gross total resection using the transcortical approach in the treatment of patients with lateral ventricular central neurocytomas. Patients and methods: This is a retrospective observational study conducted on eight patients who underwent surgical treatment for a lateral ventricular tumor that had a postoperative histopathological diagnosis of central neurocytoma via the transcortical approach. The included patients were operated upon at Ain Shams University Hospitals between October 2012 and August 2017. The postoperative clinical data were analyzed for the assessment of changes in the initial data and for any procedure-related complications. Results: The current study included two males and six females (a total of eight patients) with a mean age of 24. Seventy-five years ranging from 12 to 34 years. The main presenting symptom was a persistent headache. The mean duration of symptoms prior to diagnosis was 2.625 months ranging from 1 to 6 months. Preoperatively, five patients had hydrocephalic changes due to obstruction of the cerebrospinal fluid pathways; however, none of them had a cerebrospinal fluid diversion prior to direct tumor attack. Gross total resection (radiologically proven) was achieved in six (75%) patients. One patient had an approach-related visual field defect and one patient had postoperative epilepsy that required long-term use of antiepileptic therapy. The mean postoperative follow-up duration was 26 months ranging from 6 to 60 months. Regarding functional outcome, by the end of the third postoperative month, seven patients could achieve a score of 5 according to the Glasgow Outcome Scale. Conclusion: The transcortical approach provides a safe and effective corridor for the achievement of gross total resection of lateral ventricular central neurocytomas with the main limitation of being less effective regarding the degree of resection in cases of bilateral tumors.

Recurrent Central Neurocytoma Treated with Robotic Radiosurgery

“…An extensive tumor resection entails an aggressive surgical approach that must be carefully balanced to mitigate the risk of neurological deterioration (Xiong et al, 2015). The 5-year survival rate of a GTR and subtotal tumor resection (STR) is 99% and 86%, respectively (Xiong et al, 2015;Elayouty et al, 2018). Subtotal resection is associated with an increased recurrence rate and when performed, adjuvant radiotherapy has proved to significantly improve local control (LC), progression-free survival (PFS), and overall survival (OS) (Samhouri et al, 2021).…”

Central Neurocytoma with Hemorrhagic Presentation Case Report and Review of the Literature

“…Central neurocytoma is a rare well-differentiated neoplasm with ectodermal neuronal origin [ 7 , 8 ]. It accounts for less than 1% of all primary tumors in central nervous system (CNS) with presentation of spontaneous intraventricular hemorrhage (IVH) is exquisitely rare [ 9 , 10 ].…”

“…The mainstay treatment of CN is a total resection which can be performed directly via transcortical, transcallosal, or via endoscopic neurosurgery [ 24 , 25 ]. Total resection was achieved only in 30-50% of the cases [ 2 , 8 , 13 ] probably due to the tumor vascularity and its adherence to nearby structures [ 2 ]. Moreover, total resection of CN was associated with 99% 5-year survival rate in compassion to subtotal resection which was associated 86% 5-year survival rate [ 8 , 13 ].…”

“…Total resection was achieved only in 30-50% of the cases [ 2 , 8 , 13 ] probably due to the tumor vascularity and its adherence to nearby structures [ 2 ]. Moreover, total resection of CN was associated with 99% 5-year survival rate in compassion to subtotal resection which was associated 86% 5-year survival rate [ 8 , 13 ]. However, the serious risk of posing neurological deterioration may result from aggressive and excessive tumor resection; hence, a balance of advantages and disadvantages of the surgery should be considered [ 21 ].…”

“…Therefore, the transcallosal approach is mainly performed to operate in a tumor in the third ventricle or both lateral ventricles with normal ventricular size and to avoid cortical incision [ 2 , 10 , 15 , 21 , 25 ]. On the other hand, transcortical approach is used for easy access to the lateral ventricle tumor, to operate on large tumors, to reduce the risk of damaging the fornix and parasagittal vein, and to avoid making incision in the corpus callosum [ 2 , 8 , 15 , 25 ]. With these advantages and disadvantages for each approach, complication should be taken into consideration; before choosing the approach, hemiparesis, memory loss, aphasia, mutism, and disconnection syndromes are the most reported complications associated with the transcallosal approach.…”