The last decade's experience of management of central neurocytomas: Treatment strategies and new options

Alexander Konovalov; Sergey Maryashev; David Pitskhelauri; Vitaly Siomin; Andrey Golanov; Aleksandra Dalechina

doi:10.25259/SNI_764_2020

The last decade's experience of management of central neurocytomas: Treatment strategies and new options

Surg Neurol Int. 2021 Jul 6:12:336. doi: 10.25259/SNI_764_2020. eCollection 2021.

Authors

Alexander Konovalov¹, Sergey Maryashev¹, David Pitskhelauri¹, Vitaly Siomin², Andrey Golanov³, Aleksandra Dalechina⁴

Affiliations

¹ Department of Neurosurgery, N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.
² Department of Neurosurgery, Baptist Hospital of Miami, Miami Neuroscience Institute, Miami, Florida, United States.
³ Department of Radiation therapy and Radiosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.
⁴ Gamma Knife Center, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.

Abstract

Background: The purpose of the presented work is to evaluate the last decade's experience in surgical management of central neurocytoma (CN) and elucidate on the treatment strategies and new options.

Methods: The current series consists of the remaining 125 patients (70 females and 55 males) operated on during the past decade from 2008 to 2018. Most tumors were resected through transcortical (n = 76, 61%), or transcallosal (n = 40, 32%) approaches. In 5 (4%) patients with predominantly posterior location of the tumor, non-dominant superior parietal lobule approach was utilized. Both approaches (transcortical + transcallosal) were used in 4 (3%) of cases. Seven consecutive patients with large CN underwent prophylactic intraventricular stenting to prevent hydrocephalus.

Results: Gross total resection was achieved in 45 patients (36%), subtotal resection (STR) in 40 (32%) cases. After surgery, 63 (50%) patients had neurocognitive problems, including disorientation, attention deficit, global amnesia, short-term memory deficits, and perceptual motor and social cognition problems. A total of 26 patients (21%) had postoperative hemorrhage in the resection bed. Obstructive hydrocephalus was noted in 25 (20%) patients. The entrapment of the occipital and/or temporal horns was observed in seven cases. None of the seven patients with prophylactic intraventricular stents required shunting.

Conclusion: Although high rates of gross total or STR can be expected, the mortality and morbidity remain significant even in the modern neurosurgical era. Prophylactic intraventricular stenting in patients with large posteriorly located tumors with hydrocephalus may prevent ventricular entrapment and shunting. The main risk factors for recurrence are presence of residual disease and Ki-67 index over 5%. Recurrent symptomatic tumors should be treated surgically, whereas asymptomatic progression can be managed with stereotactic radiosurgery. Both treatment modalities are associated with low risk of complications and high tumor control rates.

Keywords: Central neurocytoma; Postoperative complications and outcomes; Radiosurgery; Stereotactic radiotherapy; Surgical resection.