Abstract
IntroductionCentral Neurocytomas (CN) are a rare intracranial tumour, most often arising in the lateral ventricles and presenting with obstructive hydrocephalus. Isolated lesions in the third ventricle are uncommon. We present the fourth reported case of posterior third ventricular CN successfully managed surgically via endoscopy, allowing for concurrent biopsy and therapeutic endoscopic third ventriculostomy (ETV). Stereotactic radiosurgery was administered for the residual lesion. A brief review of CNs and previous similar cases is also provided. Presentation of caseA 58-year-old male presented with progressive decline in cognition and gait. Subsequent Magnetic Resonance Imaging revealed obstructive hydrocephalus secondary to a posterior third ventricular lesion. An endoscopic biopsy and concurrent cerebrospinal fluid diversion by ETV was performed. Pathological analysis was consistent with a CN with positivity to Synaptophysin. MIB-1 proliferation index was 1%. There was good clinical recovery, and the patient underwent adjuvant stereotactic radiosurgery 1.5 months post-surgery. DiscussionDue to the rarity of CNs arising from the third ventricle, there are only three previous reports of these approached endoscopically. Such a technique allows for good visualisation of the lesion, and therapeutic ETV to relieve obstructive hydrocephalus. This case supports this approach as a valid, minimally invasive option. Additionally, this is the first case to report the MIB-1 proliferation index, contributing to future outcome evaluation of endoscopic approaches to typical (MIB-1 < = 2%) verses atypical (MIB-1 > 2%) CNs. ConclusionEndoscopic biopsy with concurrent ETV and adjuvant stereotactic radiosurgery is a valid treatment option for deep seated isolated small posterior third ventricular CNs.
Highlights
Central Neurocytomas (CN) are a rare intracranial tumour, most often arising in the lateral ventricles and presenting with obstructive hydrocephalus
In line with surgical CAse REport (SCARE) guidelines [4], we present a case of a posterior third ventricular CN with MIB-1 proliferation index 1% that was surgically biopsied via an endoscopic approach with concurrent endoscopic third ventriculostomy (ETV), and adjuvant radiosurgery for residual disease
CNs are very rare, making up only 0.1–0.5% of central nervous system tumours, and peak incidence is between 20–40 years of age [1,2]
Summary
Central Neurocytomas (CN) are a rare intracranial tumour, most often arising in the lateral ventricles and presenting with obstructive hydrocephalus. DISCUSSION: Due to the rarity of CNs arising from the third ventricle, there are only three previous reports of these approached endoscopically Such a technique allows for good visualisation of the lesion, and therapeutic ETV to relieve obstructive hydrocephalus. This case supports this approach as a valid, minimally invasive option. This is the first case to report the MIB-1 proliferation index, contributing to future outcome evaluation of endoscopic approaches to typical (MIB-1 < = 2%) verses atypical (MIB-1 > 2%) CNs. CONCLUSION: Endoscopic biopsy with concurrent ETV and adjuvant stereotactic radiosurgery is a valid treatment option for deep seated isolated small posterior third ventricular CNs
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