Artikel
Chordoid glioma – a rarity of the third ventricle – report of three cases and meta-analysis of neurosurgical and neuropathological reports
Chordoides Gliom – eine Rarität des dritten Ventrikels – Falldarstellung von 3 Patienten und Metaanalyse von neurochirurgischen und neuropathologischen Studien
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Autoren
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Johannes Wach
- Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland; Asklepios Klinik Nord Hamburg, Neurochirurgie, Hamburg, Deutschland
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Claudia Goetz
- Asklepios Klinik Nord Hamburg, Neurochirurgie, Hamburg, Deutschland
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Kasra Shareghi
- Asklepios Klinik Nord Hamburg, Neurochirurgie, Hamburg, Deutschland
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Torben Scholz
- Asklepios Klinik Nord Hamburg, Neurochirurgie, Hamburg, Deutschland
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Volker Hesselmann
- Asklepios Klinik Nord Hamburg, Neuroradiologie, Hamburg, Deutschland
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Joachim Gottschalk
- Asklepios Klinik Nord Hamburg, Neuropathologie, Hamburg, Deutschland
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Paul Kremer
- Asklepios Klinik Nord Hamburg, Neurochirurgie, Hamburg, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Chordoid gliomas (CG) are rare neoplasms within the anterior part of the third ventricle. The present study analyzed all cases of CG within the literature in order to identify the recurrence-free survival, neurosurgical approaches, VP-shunt dependency and immunohistochemical profile. Furthermore we present three cases reports of our department.
Methods: A systematic meta-analysis adhering to PRISMA guidelines was done. Kaplan-Meier analysis of recurrent-free survival in 42 cases and Pearson’s chi-squared tests to analyze extent of resection, surgical approaches and VP-Shunt dependency in 66 cases were performed. Clinical symptoms, MRI features and immunohistochemistry were analyzed in 70 cases. Mean and median follow-up were 19.8 and 13.5 months in the patient collective. Three own cases are reported with focus on clincal symptoms, surgical results, follow-up and immunhistochemical profile.
Results: There is a female predominance (male:female: 1:1.8) of the CG and the mean age is 44.2+/-13.11. Main symptoms are headache (51.4%), visual deterioration (41.4%) and memory deficits (21.4%). MRI shows a homogenously enhancing solid suprachiasmal tumor mass in 84.8% with cystic appearance in 20%. The rate of recurrence in subtotal resection (STR) was 20.0% compared to 0% in the gross total resection (GTR) group (p: 0.034). Patients with STR suffered from postoperative VP-Shunt dependency in 19.2% and 5.0% in GTR (p: 0.067). Subfrontal (rGTR: 83.33%; p: 0.041) or pterional trans-lamina terminalis approach (rGTR: 63.64%; p:0.095) seem to be the surgical route of choice. Perioperative mortality was 15.7%. GFAP (100%), Vimentin (100%) and CD 34 (69.6%) are the strongest immunohistochemical markers. Two female (40 and 67 years old) and one male patient (44 years old) were treated by a subfrontal trans-lamina terminalis approach in our department. Two were treated with a GTR and one with STR. However, the CG treated by STR had a recurrence after 18 months.
Conclusion: Despite their histologically benign nature as a WHO grade II tumour, CG have a high rate of recurrence. Morphologically, CG are solid homogenously enhancing tumours. CG should be surgically resected with a GTR, preferably by the trans-lamina terminalis route. Furthermore, signs of postoperative VP-Shunt dependency should be noted after STR. Anatomical and immunohistochemical features seem to show tancytic origin of this entity.
