The Diagnosis And Treatment Of Central Neuroytoma:Report Of17Cases

Background and ObjectiveCentral neurocytomas(CNs), usually locating in the lateral ventricle, is thought to originate from bipotential (neuronal and astrocytic) progenitor cells in the periventricular region that persist into adulthood. Defined by Hassoun et al. in1982as a distinct pathological entity, CNs only compromise0.25-0.5%of tumors in central nervous system. Since most clinical series are small to this day, the diagnosis and treatment of CNs remain controversial. Despite a major portion of patients with CNs have a favorable prognosis, clinical courses of a few cases are reported to be malignant. The monoclonal antibody of cell proliferation associated nuclear antigen (MIB-1) is claimed to be the only biomolecular marker which can predict relapse sensitively. The most important therapeutic modality is surgery as primary therapy or for relapsing tumor, and a safe maximal resection delivers the best clinical outcome. Traditional radiation and stereotactic radiosurgery are performed in cases of a subtotal resection and recurrences as an adjuvant therapy or as an alternated choice for patients who receive biopsy but refuse surgery. Chemotherapy may be useful as an adjuvant therapy too although long-term responses still remain to be investigated.Materials and methods:A retrospective analysis of17patients (7male and10female) admitted in our hospital since2005has been delivered with all tumors were diagnosed by Immunohistochemistry test. The mean age of presentation was28years (range from17to38). The mean course was8months. All of the patients had a significant period of headache before admitted into our hospital, along with N&V(15), light hemiplegic paralysis(7), or instability gait(3). Pre-operation magnetic resonance imaging (MRI) was performed with management of gadolinium. In all of the tumors,8were in one side of the ventricle, the other8ocuppied in both sides of the lateral ventricle, and the last one was in the third ventricle. All of the patients received microsurgery as primary therapy with GTR(10) and STR(7). Immunohistochemistry test revealed that NSE and Syn were positive in14patients, and GFAP positive in5patients.ResultsTwo of the patients died of complications after operation. Radiotherapy was performed for the patients who had STR and one patient who received GTR but the immunohistochemistry test revealed that whose MIB-LI was above2%.15patients were in close observation after discharging from our hospital. During the follow-up, despite one of them had toxicity reaction to radiotherapy, the rest of them had no evidence of relapse and were in satisfied condition. The prognosis is favorable with an overall5-year survival rate of88.2%.ConclusionsCNs are a rare kind of pathological entity of intracranial tumors. The most important therapy is still microsurgery. A safe and maximum resection ensures a satisfied outcome. Radiotherapy is a reliable option as adjuvant measure for those patients with relapse or residual tumor especially gamma knife which already have been proved to have a encouraging progress. Chemotherapy may be useful for recurrent CNs that cannot be resected and have been radiated, although long-term responses have not been reported. Despite benign behavior of these tumor, some of them are reported to be malignant especially with MIB-LI above2%.