Treatment Strategies for Huge Central Neurocytomas

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 neurocytomas:clinical analysis of 94 cases

Objective To analyze the clinical characteristics of central neurocytomas,and discuss the therapeutic strategies. Methods 94 cases of central neurocytomas were studied retrospectively. All patients underwent operation with removal of the tumor through either transcallosal or transcortical approach. Total resection was

Clinicopathological Analysis of Central and Extraventricular Neurocytoma:A Report of 17 Cases

Neurocytoma,a rare brain tumor,is characterized by a mass located mainly in cerebral ventricles.It is prone to be misdiagnosed as oligodendroglioma or ependymoma due to their similar histopathological features in clinical practice.This study aimed to examine the clinicopathological features and differential diagnosis of central and extraventricular neurocytoma.The clinical and histopathological data of 17 patients (male:female=7:10;age:4-41 years;mean age:27.4 years) with central or extraventricular neurocytoma were retrospectively analyzed.These patients showed typical radiological,histopathological and immunohistochemical features of neurocytoma.The tumor tissue was found to be composed of small uniform cells with round nuclei and clear cytoplasm resembling that of oligodendroglioma and ependymoma.Immunohistochemistry revealed the tumor tissues were positive for neuronal markers such as synaptophysin (SYN) and neuronal nuclear antigen (NeuN).It was concluded histopathological features of neurocytoma overlaps with some tumors in the central neural system.Immunopositivity for SYN and NeuN can help differentially diagnose neurocytoma.

Pathologic features and clinical outcome of central neurocytoma:analysis of 15 cases

Objective： To get better recognition of central neurocytoma and diminish misdiagnosis. Methods： A retrospective review identified 15 cases of central neurocytoma. All cases of central neurocytoma were analyzed for their clinical symptoms, pathologic changes, immunohistochemical staining, prognosis and differential diagnosis. Clinical follow up was performed. Results： There were 8 males and 7 females aged 10-64 years （median 32.93 years）. The most common presenting symptoms were those related to increased intracranial pressure （ICP）, including headache （100%）, papilledema （93 %） and vomiting （80%）. All tumors were located in the ventricular system. The tumors were composed of uniform cells with round nuclei and a fine chromatin pattern, and in some areas, small cells with perinuclear halo could be seen. In particular, the anuclear areas may have a fine fibrillary matrix （neuropil）. Nuclear atypia and vascular proliferation appeared in two cases, respectively. Focal necrosis could be seen in one case. Immunohistochemical findings included expression of synaptophysin （15/15）, neuron specific enolase （12/15） and glial fibrillary acidic protein （GFAP） （3/15）. MIB-1 proliferation index ranged from 0.8- 12.5%, and was more than 2% in 3 of 15 cases assessed. Follow-up information of 11 patients was available. Conclusions： Central neurocytoma has a favorable prognosis in general, but in some cases, the clinical course could be aggressive. Increase of GFAP positivity, proliferation index and vascular proliferation might suggest a more malignant process.

Central Neurocytoma and Epidermoid Tumor Occurring as Collision Tumors: A Rare Association

Different brain tumors of distinct histology can co-exist in the setting of phakomatoses or as a complication of radiotherapy. In the absence of these predisposing factors, this phenomenon is uncommon. When the lesions are in close proximity they are described as collision tumors and are extremely rare. A 58-year-old woman presented with persistent headache and cognitive decline for three months. Magnetic resonance imaging revealed a tumor arising from the atrium of the left lateral ventricle with heterogeneous contrast enhancement. This intraventricular lesion was adjacent to another extensive infiltrating tumor of the basal cisterns. Operative findings revealed a vascular ventricular tumor and gross total resection was achieved. An adjacent avascular basal cistern tumor with a pearly white sheen was encountered and partial excision was performed. The histopathological diagnosis was central neurocytoma and epidermoid tumor. There is only one documented description of a central neurocytoma co-existing with a tumor of different pathology. To our knowledge, this is the first reported collision tumor case involving central neurocytoma. Since the incidence of both lesions co-existing juxtaposed is extremely low, a chronic oncogenetic inflammatory process stimulated by the epidermoid tumor to the subventricular region is suggested. Other mechanisms for tumor collision are discussed and we suggest a classification system for this rare association to reflect their pathogenesis.

Emotion and cognitive function assessment of patients with central neurocytoma resection through transcortical frontal approach： a 5-year postoperative follow-up study

Background Central neurocytoma accounts for 0.1% of primary brain tumor that often occurs in young adults. Surgery is the main treatment for central neurocytoma and the rate of 5-year survival reaches up to over 90%. This study aimed to assess the effect of transcortical frontal approach to surgical resection of central neurocytoma on emotion and cognitive function 5 years after surgery. Methods Telephone following-up visits were used in this study. By means of neuropsychological testing, assayed emotion, memory and abstract thinking ability of 18 patients undergoing central neurocytoma resection by transcortical frontal approach for 5 years or more, with another 21 normal cases as control group were enrolled. The data were analyzed statisticaJly by paired t test with SPSS11.5. Results Patients whose central neurocytoma was removed by transcortical frontal approach were not affected on calculating ability 5 years after operation while ability of memory declined sharply （P=-0.000）, the older, the more sharply （P=0.036）. Ability of abstract thinking was significantly reduced （P=0.000）, the older, the more significantly as well （P=-0.012）; additionally, anxiety and depression occurred in patients rather more than those of control group （P=0.000）, especially cognitive impairment. Conclusions Transcortical frontal approach for surgical resection of central neurocytoma has certain long-term influence on patients＇ life quality, vulnerable to anxiety, depression and cognitive impairment, the severity of which was correlated to age. Therefore, imDrovina suroical aoDroach will be of value for better Iona-term life aualitv of oatients.

Clinical and pathological characteristics of septum pellucidum tumor and choice of surgical approaches for its resection

Background Tumor involving the septum pellucidum is uncommon. Surgery as the main therapeutic procedure for this lesion is a challenge to neurosurgeons. We analyzed the clinical characteristics and pathological features of septum pellucidum tumor in 41 patients and compared the curative effects of frontal transcortical, trans-sulcal and interhemispheric transcallosal approaches. Methods Clinical characteristics and the pathological features of septum pellucidum tumor were investigated retrospectively in 41 patients. The differences in postoperative residual rates, extents of tumors and resection of normal brain tissues after use of the three approaches in these patients were analyzed statistically. Results Septum pellucidum tumor is more likely to attack young or middle-aged persons. The tumor mainly presents itself as a central neurocytoma or cerebral low-grade glioma in pathology and manifests as intracranial hypertension clinically. No difference was found in the extent of tumor resection but significant difference in the extent of normal brain tissue resection and in postoperative disability rate among the three approaches. The transcortical approach brought about the most serious injury to brain tissue and the highest disability rate, Whereas the frontal transcallosal approach the lightest injury and the lowest disability rate. The injury to brain tissue and the disability rate brought about by the front trans-sulcus approach were between the above two approaches. Conclusions Operation is still regarded the major treatment for septum pellucidum tumor. Transcallosal and trans-sulcus approaches are fit with the concept of minimally invasive surgery, and transcallosal approach is the first choice for septum pellucidum tumor.

Rapid local recurrence of an extraventricular neurocytoma that had disappeared after gamma knife radiosurgery

Central neurocytoma （CN）, first described by Hassoun et al in 1982, is a rare neuronal tumor of the centralnervous system, and accounts for 0.25%-0.5% of all intracranial tumors. CN commonly occurs as an intraventricular mass but may also occur as a periventricular parenchymal mass or even in locations remote from the ventricles, in which case it is termed as an extraventricular neurocytoma （EVN） （cerebral）. EVNs show a wide variability with regard to morphologic features, cellularity, and proliferation rate and are more frequently associated with poorer clinical outcomes than CNs. 1 To our knowledge, little is known regarding the treatment of atypical neurocytomas.