University of Connecticut School of Medicine, 06030 Farmington, CT, USA.
Department of Neurosurgery, Hartford Hospital, 85 Seymour Street, Suite 1003, 06106 Hartford, CT, USA.
Neurochirurgie. 2020 Nov;66(5):391-395. doi: 10.1016/j.neuchi.2020.03.002. Epub 2020 Jun 2.
Central Neurocytomas (CNs) are rare brain tumors, making up less than 1% of all primary tumors within the CNS. They are commonly located in the lateral ventricles, and often present with visual changes and symptoms of obstructive hydrocephalus. Histopathology shows characteristics similar to ependymomas and oligodendrogliomas, however tumor cells display neuronal differentiation, and immunohistochemical stains typically for synaptophysin. Gross total resection is the most important prognostic indicator of survival.
We describe the case of a 48-year-old male with a CN originating in the third ventricle with expansion through the cerebral aqueduct into the fourth ventricle. He presented with bi-frontal headaches, imaging revealed an avidly enhancing tumor occupying the inferior third ventricle, cerebral aqueduct, with expansion into the fourth ventricle. An interhemispheric craniotomy with a transcallosal transchoroidal approach to the third ventricle was performed, this provided a trajectory that paralleled the long axis of the tumor. Postoperative imaging confirmed a near total resection with linear residual enhancement on the anterior wall of the fourth ventricle. Intensity modulated radiotherapy was performed, 7-month follow-up imaging was clean.
CNs are rare brain tumors, most commonly located within the lateral ventricles. We describe a rare case of a CN spanning from the third ventricle into the cerebral aqueduct and fourth ventricle. To our knowledge, this is only the fourth reported case of such a tumor. Surgical approach must be carefully selected, as gross total resection is the most important prognostic indicator.
中枢神经细胞瘤（CNs）是一种罕见的脑肿瘤，在中枢神经系统的所有原发性肿瘤中不到 1%。它们通常位于侧脑室，常表现为视力改变和阻塞性脑积水的症状。组织病理学显示与室管膜瘤和少突胶质细胞瘤相似的特征，但肿瘤细胞显示出神经元分化，免疫组织化学染色通常为突触素。大体全切除是生存的最重要预后指标。
我们描述了一例 48 岁男性，CN 起源于第三脑室，通过大脑导水管扩展到第四脑室。他表现为双额头痛，影像学显示一个强烈增强的肿瘤占据了下三分之一脑室、大脑导水管，并扩展到第四脑室。行额间开颅术，经胼胝体-脉络丛入路进入第三脑室，该入路提供了与肿瘤长轴平行的轨迹。术后影像学证实了近乎完全切除，第四脑室前壁有线性残留增强。进行了强度调制放疗，7 个月后的随访影像学结果干净。
CNs 是罕见的脑肿瘤，最常见于侧脑室。我们描述了一例罕见的 CN 从第三脑室延伸到大脑导水管和第四脑室的病例。据我们所知，这只是第四个这样的肿瘤的报告病例。手术方法必须仔细选择，因为大体全切除是最重要的预后指标。
