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.