The importance of staged surgery for giant atypical central neurocytoma
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ORIGINAL ARTICLE
The importance of staged surgery for giant atypical central neurocytoma Jennyfer Paulla Galdino Chaves1 · Carlos Alberto Mattozo2 · Bruno Augusto Telles2 · Ana Paula Percicote3 · Zeferino Jr Demartini1 · Adriano Keijiro Maeda4 Received: 13 July 2020 / Accepted: 17 August 2020 © Belgian Neurological Society 2020
Abstract The aim of this article is to discuss the importance of staged surgeries when approaching atypical central neurocytoma in children. Also, we show the preoperative embolization of the lesion as a maneuver to reduce the intraoperative bleeding. Central neurocytomas represent less than 0.5% of all intracranial tumors, and atypical central neurocytomas usually have unfavorable outcome, with high recurrence rate. The intraventricular location is frequent, with a predilection for the lateral ventricles. When completely resected, these lesions have a good prognosis. We report a case of a 12-year old male patient that presented with a history of headache for about 6 months, which worsened for 1 week prior to admission. Magnetic resonance imaging (MRI) brain showed a massive lesion occupying both lateral ventricles. He underwent a microsurgical treatment of a highly vascularized lesion, but the perioperative bleeding required interruption of the surgery. Thus, a preoperative embolization was able to occlude most arterial feeders and allowed subtotal resection in a second surgery. The patient had complete neurological recovery despite immediate post-operative deficits, and the histopathology was suggestive of atypical neurocytoma. Two-stage surgery with preoperative adjuvant embolization is a feasible strategy for treatment of large central neurocytomas in children. Keywords Neurocytoma · Child · Brain neoplasms
Introduction Neurocytomas are well-differentiated benign tumors, which appear in young adults and are uncommon in the pediatric population. They represent less than 0.5% of all intracranial tumors, and can be located in lateral ventricles in the region of the foramen of Monro or in the brain parenchyma [1, 2]. The first one is classified as central neurocytoma and the * Jennyfer Paulla Galdino Chaves [email protected] Carlos Alberto Mattozo [email protected] Bruno Augusto Telles [email protected] Ana Paula Percicote [email protected] Zeferino Jr Demartini [email protected] Adriano Keijiro Maeda [email protected]
second one as extraventricular neurocytoma [2]. The atypical neurocytomas, which appears with MIB-L1 > 2%, does not have a favorable outcome, with high recurrence rate [1, 2]. We report a case of a 12-year old boy with a massive neoplasm treated with two staged surgery.
1
Neurosurgery Department of Cajuru University Hospital, 300, São José street ‑ Cristo Rei, Curitiba‑ PR 80050‑350, Brazil
2
Radiology Department of Pequeno Príncipe Hospital, 1070 Desembargador Motta street, Água Verde, Curitiba‑PR 80250‑060, Brazil
3
Pathology Department of Pequeno Príncipe Hospital, 1070 Desembargador Motta street, Água Verde, C
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