ИСТИНА

Objective: Central neurocytoma (CN) is a very uncommon central nervous system (CNS) tumor with features of both glial and neuronal differentiation. Almost five hundred cases of CN have been reported in the literature. The purpose of the presented work is to evaluate the last decade’s experience in surgical management of 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. All tumors were located in the ventricles. Symptoms associated with raised intracranial pressure (ICP) were the most common clinical presenting findings in this series. Most tumors were resected via 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 (GTR) was achieved in 45 patients (36%), subtotal resection (STR) in 40 (32%) cases. Extent of resection depends on the size of the tumor. GTR/STR was achieved in 100% of patients with tumors <2.0 cm in largest diameter, in 69% of patients with tumors measuring 2-4 cm, in 66% with tumors measuring 4-6 cm and in only 50% when lesions were larger than 6 cm. 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. None of the 7 patients with prophylactic intraventricular stents required shunting. Conclusions: CN remains surgically challenging lesion. Although high rates of gross total or subtotal resection can be expected, the mortality and morbidity remain significant even in the modern neurosurgical era, regardless of the approach. Large size of the tumor, presence of hydrocephalus and preoperative neurological or cognitive deficits are associated with lesser extent of resection and poorer outcome. Prophylactic intraventricular stenting in patients with large posteriorly located tumors with hydrocephalus may prevent ventricular entrapment and shunting.