Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature
Abstract Background Intraventricular neuroepithelial tumors (IVT) are rare lesions and comprise different pathological entities such as ependymomas, subependymomas and central neurocytomas. The treatment of choice is neurosurgical resection, which can be challenging due to their intraventricular loc...
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | BMC Cancer |
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| Online Access: | http://link.springer.com/article/10.1186/s12885-020-07570-1 |
| _version_ | 1819212780921683968 |
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| author | A. Kaywan Aftahy Melanie Barz Philipp Krauss Friederike Liesche Benedikt Wiestler Stephanie E. Combs Christoph Straube Bernhard Meyer Jens Gempt |
| author_facet | A. Kaywan Aftahy Melanie Barz Philipp Krauss Friederike Liesche Benedikt Wiestler Stephanie E. Combs Christoph Straube Bernhard Meyer Jens Gempt |
| author_sort | A. Kaywan Aftahy |
| collection | DOAJ |
| description | Abstract Background Intraventricular neuroepithelial tumors (IVT) are rare lesions and comprise different pathological entities such as ependymomas, subependymomas and central neurocytomas. The treatment of choice is neurosurgical resection, which can be challenging due to their intraventricular location. Different surgical approaches to the ventricles are described. Here we report a large series of IVTs, its postoperative outcome at a single tertiary center and discuss suitable surgical approaches. Methods We performed a retrospective chart review at a single tertiary neurosurgical center between 03/2009–05/2019. We included patients that underwent resection of an IVT emphasizing on surgical approach, extent of resection, clinical outcome and postoperative complications. Results Forty five IVTs were resected from 03/2009 to 05/2019, 13 ependymomas, 21 subependymomas, 10 central neurocytomas and one glioependymal cyst. Median age was 52,5 years with 55.6% (25) male and 44.4% (20) female patients. Gross total resection was achieved in 93.3% (42/45). 84.6% (11/13) of ependymomas, 100% (12/21) of subependymomas, 90% (9/10) of central neurocytomas and one glioependymal cyst were completely removed. Postoperative rate of new neurological deficits was 26.6% (12/45). Postoperative new permanent cranial nerve deficits occurred in one case with 4th ventricle subependymoma and one in 4th ventricle ependymoma. Postoperative KPSS was 90% (IR 80–100). 31.1% of the patients improved in KPSS, 48.9% remained unchanged and 20% declined. Postoperative adverse events rate was 20.0%. Surgery-related mortality was 2.2%. The rate of shunt/cisternostomy-dependent hydrocephalus was 13.3% (6/45). 15.4% of resected ependymomas underwent adjuvant radiotherapy. Mean follow-up was 26,9 (±30.1) months. Conclusion Our surgical findings emphasize satisfactory complete resection throughout all entities. Surgical treatment can remain feasible, if institutional experience is given. Satisfying long-term survival and cure is possible by complete removal. Gross total resection should always be performed under function-remaining aspects due to mostly benign or slow growing nature of IVTs. Further data is needed to evaluate standard of care and alternative therapy options in rare cases of tumor recurrence or in case of patient collective not suitable for operative resection. |
| first_indexed | 2024-12-23T06:48:25Z |
| format | Article |
| id | doaj.art-76a05c218dd148cf822892c931c770a7 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-23T06:48:25Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-76a05c218dd148cf822892c931c770a72022-12-21T17:56:31ZengBMCBMC Cancer1471-24072020-11-0120111410.1186/s12885-020-07570-1Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literatureA. Kaywan Aftahy0Melanie Barz1Philipp Krauss2Friederike Liesche3Benedikt Wiestler4Stephanie E. Combs5Christoph Straube6Bernhard Meyer7Jens Gempt8Department of Neurosurgery, Technical University Munich, Medical Faculty, School of Medicine, Klinikum rechts der IsarDepartment of Neurosurgery, Technical University Munich, Medical Faculty, School of Medicine, Klinikum rechts der IsarDepartment of Neurosurgery, Technical University Munich, Medical Faculty, School of Medicine, Klinikum rechts der IsarDepartment of Neuropathology, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Institute of PathologyDepartment of Neuroradiology, Technical University Munich, School of Medicine, Klinikum rechts der IsarDepartment of Radiation Oncology, Technical University Munich, School of Medicine, Klinikum rechts der IsarDepartment of Radiation Oncology, Technical University Munich, School of Medicine, Klinikum rechts der IsarDepartment of Neurosurgery, Technical University Munich, Medical Faculty, School of Medicine, Klinikum rechts der IsarDepartment of Neurosurgery, Technical University Munich, Medical Faculty, School of Medicine, Klinikum rechts der IsarAbstract Background Intraventricular neuroepithelial tumors (IVT) are rare lesions and comprise different pathological entities such as ependymomas, subependymomas and central neurocytomas. The treatment of choice is neurosurgical resection, which can be challenging due to their intraventricular location. Different surgical approaches to the ventricles are described. Here we report a large series of IVTs, its postoperative outcome at a single tertiary center and discuss suitable surgical approaches. Methods We performed a retrospective chart review at a single tertiary neurosurgical center between 03/2009–05/2019. We included patients that underwent resection of an IVT emphasizing on surgical approach, extent of resection, clinical outcome and postoperative complications. Results Forty five IVTs were resected from 03/2009 to 05/2019, 13 ependymomas, 21 subependymomas, 10 central neurocytomas and one glioependymal cyst. Median age was 52,5 years with 55.6% (25) male and 44.4% (20) female patients. Gross total resection was achieved in 93.3% (42/45). 84.6% (11/13) of ependymomas, 100% (12/21) of subependymomas, 90% (9/10) of central neurocytomas and one glioependymal cyst were completely removed. Postoperative rate of new neurological deficits was 26.6% (12/45). Postoperative new permanent cranial nerve deficits occurred in one case with 4th ventricle subependymoma and one in 4th ventricle ependymoma. Postoperative KPSS was 90% (IR 80–100). 31.1% of the patients improved in KPSS, 48.9% remained unchanged and 20% declined. Postoperative adverse events rate was 20.0%. Surgery-related mortality was 2.2%. The rate of shunt/cisternostomy-dependent hydrocephalus was 13.3% (6/45). 15.4% of resected ependymomas underwent adjuvant radiotherapy. Mean follow-up was 26,9 (±30.1) months. Conclusion Our surgical findings emphasize satisfactory complete resection throughout all entities. Surgical treatment can remain feasible, if institutional experience is given. Satisfying long-term survival and cure is possible by complete removal. Gross total resection should always be performed under function-remaining aspects due to mostly benign or slow growing nature of IVTs. Further data is needed to evaluate standard of care and alternative therapy options in rare cases of tumor recurrence or in case of patient collective not suitable for operative resection.http://link.springer.com/article/10.1186/s12885-020-07570-1Intraventricular tumorNeuroepithelialEpendymomaSubependymomaCentral neurocytomaSurgical technique |
| spellingShingle | A. Kaywan Aftahy Melanie Barz Philipp Krauss Friederike Liesche Benedikt Wiestler Stephanie E. Combs Christoph Straube Bernhard Meyer Jens Gempt Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature BMC Cancer Intraventricular tumor Neuroepithelial Ependymoma Subependymoma Central neurocytoma Surgical technique |
| title | Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature |
| title_full | Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature |
| title_fullStr | Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature |
| title_full_unstemmed | Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature |
| title_short | Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature |
| title_sort | intraventricular neuroepithelial tumors surgical outcome technical considerations and review of literature |
| topic | Intraventricular tumor Neuroepithelial Ependymoma Subependymoma Central neurocytoma Surgical technique |
| url | http://link.springer.com/article/10.1186/s12885-020-07570-1 |
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