Distant recurrence in the cerebellar dentate nucleus through the dentato-rubro-thalamo-cortical pathway in supratentorial glioma cases

Masayuki Kanamori; Yohei Morishita; Yoshiteru Shimoda; Eiko Yamamori; Shiho Sato; Yoshinari Osada; Shin-Ichiro Osawa; Ichiyo Shibahara; Ryuta Saito; Yukihiko Sonoda; Toshihiro Kumabe; Hidenori Endo

doi:10.1007/s00701-024-05981-8

Distant recurrence in the cerebellar dentate nucleus through the dentato-rubro-thalamo-cortical pathway in supratentorial glioma cases

Acta Neurochir (Wien). 2024 Feb 14;166(1):83. doi: 10.1007/s00701-024-05981-8.

Authors

Affiliations

¹ Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan. mkanamori@med.tohoku.ac.jp.
² Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
³ Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
⁴ Department of Neurosurgery, Kitasato University Graduate School of Medicine, Kanagawa, Japan.
⁵ Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁶ Department of Neurosurgery, Yamagata University Graduate School of Medicine, Yamagata, Japan.

Abstract

Background: Distant recurrence can occur by infiltration along white matter tracts or dissemination through the cerebrospinal fluid (CSF). This study aimed to clarify the clinical features and mechanisms of recurrence in the dentate nucleus (DN) in patients with supratentorial gliomas. Based on the review of our patients, we verified the hypothesis that distant DN recurrence from a supratentorial lesion occurs through the dentato-rubro-thalamo-cortical (DRTC) pathway.

Methods: A total of 380 patients with supratentorial astrocytoma, isocitrate dehydrogenase (IDH)-mutant (astrocytoma), oligodendroglioma, IDH mutant and 1p/19q-codeleted (oligodendroglioma), glioblastoma, IDH-wild type (GB), and thalamic diffuse midline glioma, H3 K27-altered (DMG), who underwent tumor resection at our department from 2009 to 2022 were included in this study. Recurrence patterns were reviewed. Additionally, clinical features and magnetic resonance imaging findings before treatment, at the appearance of an abnormal signal, and at further progression due to delayed diagnosis or after salvage treatment of cases with recurrence in the DN were reviewed.

Results: Of the 380 patients, 8 (2.1%) had first recurrence in the DN, 3 were asymptomatic when abnormal signals appeared, and 5 were diagnosed within one month after the onset of symptoms. Recurrence in the DN developed in 8 (7.4%) of 108 cases of astrocytoma, GB, or DMG at the frontal lobe or thalamus, whereas no other histological types or sites showed recurrence in the DN. At the time of the appearance of abnormal signals, a diffuse lesion developed at the hilus of the DN. The patterns of further progression showed that the lesions extended to the superior cerebellar peduncle, tectum, tegmentum, red nucleus, thalamus, and internal capsule along the DRTC pathway.

Conclusion: Distant recurrence along the DRTC pathway is not rare in astrocytomas, GB, or DMG at the frontal lobe or thalamus. Recurrence in the DN developed as a result of the infiltration of tumor cells through the DRTC pathway, not dissemination through the CSF.

Keywords: Dentate nucleus; Dentato-rubro-thalamo-cortical pathway; Distant recurrence; Supratentorial glioma.

MeSH terms

Astrocytoma*
Cerebellar Nuclei
Glioblastoma*
Glioma* / diagnostic imaging
Glioma* / surgery
Humans
Isocitrate Dehydrogenase
Oligodendroglioma*

Substances

Isocitrate Dehydrogenase