Treatment strategies for huge central neurocytomas

Abstract

Central neurocytomas (CNs), initially asymptomatic, sometimes become huge before detection. We described and analyzed the clinical, radiological, operational and outcome data of 13 cases of huge intraventricular CNs, and discussed the treatment strategies in this study. All huge CNs (n=13) in our study were located in bilateral lateral ventricle with diameter ≥5.0 cm and had a broad-based attachment to at least one side of the ventricle wall. All patients received craniotomy to remove the tumor through transcallosal or transcortical approach and CNs were of typical histologic and immunohistochemical features. Adjuvant therapies including conventional radiation therapy (RT) or gamma knife radiosurgery (GKRS) were also performed postoperatively. Transcallosal and transcortical approaches were used in 8 and 5 patients, respectively. Two patients died within one month after operation and 3 patients with gross total resection (GTR) were additionally given a decompressive craniectomy (DC) and/or ventriculoperitoneal shunt (VPS) as the salvage therapy. Six patients received GTR(+RT) and 7 patients received subtotal resection (STR)(+GKRS). Eight patients suffered serious complications such as hydrocephalus, paralysis and seizure after operation, and patients who underwent GTR showed worse functional outcome [less Karnofsky performance scale (KPS) scores] than those having STR(+GKRS) during the follow-up period. The clinical outcome of huge CNs seemed not to be favorable as that described in previous reports. Surgical resection for huge CNs should be meticulously considered to guarantee the maximum safety. Better results were achieved in STR(+GKRS) compared with GTR(+RT) for huge CNs, suggesting that STR(+GKRS) may be a better treatment choice. The recurrent or residual tumor can be treated with GKRS effectively.

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

“…The contrast enhancement in MRI is variable, but moderate enhancement is frequently observed. When T1- and T2-weighted MRI hypointensities or patches without signals are seen, they indicate the presence of cyst, calcification, or hemorrhage [ 10 , 13 , 16 , 17 , 20 , 21 ].…”

“…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 ]. Based on a systematic review, the complications rate after gross total resection of CN was 31.2%.…”

“…Yet, the surgical approach should be individualized [ 9 , 24 ]. In general, surgical resection of CN carries challenge due to its huge size, location in the deep midline close to critical intraventricular structures, and occasional hypervascularity of the tumor [ 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 ].…”

“…In general, surgical resection of CN carries challenge due to its huge size, location in the deep midline close to critical intraventricular structures, and occasional hypervascularity of the tumor [ 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 ].…”

RIS-assisted Wireless Channel Characteristic in Coal Mine Tunnel Based on 6G Mobile Communication System

“…RIS, as a passive reflective material, possesses the capability to actively control electromagnetic wave beams in wireless environments, enabling beamforming and lossless reflection. The authors in [15] provided a comprehensive overview of RIS design work from the perspectives of prototype system and unit design. They also categorized and reviewed channel modeling for RIS-assisted indoor communications.…”