gms | German Medical Science

Objective: Intraventricular tumors represent a rare and challenging neurosurgical entity. Complete surgical resection is the treatment of choice, if feasible, for any tumor identity. Here, we report 97 patients with classical primary intraventricular tumors that underwent surgery at our institution.

Methods: 97 consecutive patients with primary intraventricular tumors treated between 1987 and 2018 were included. Tumor types included ependymoma (n=25), subependymoma (n=26), neurocytoma (n=19), plexuspapilloma (n=13) and meningioma (n=14). Patient demographics, clinical presentation, imaging data, histology and surgical treatment with related morbidity was analyzed from patients charts and surgical reports. Clinical outcome was assessed using the modified Rankin Scale (mRS) and Spitzer Index for quality of life (SQLI).

Results: 45 male and 52 female patients with a mean age of 43,9 years (range 3 to 78 years) were included. Main presenting symptoms of patients were headaches (50.5%) and hydrocephalus (42.7%). Surgical approaches included transcortical (29.9%), transcallosal (27.8), or subocciptal (36.1%) routes depending on tumor location. The overall rate of perioperative mortality was 3% (n=3) and postoperative morbidity with permanent neurological deficits was 15% (n=14) and transient deficits 25% (n=23) with no difference between the different tumor types or localizations. Gross-total resection was achieved in 69 patients (71.1%), subtotal resection in 24 (24.7%) with more frequent subtotal resections of neurocytoma. 4 biopsies were performed. With a mean follow up of 52 month recurrences occurred in 17.2% (n=16) and the PFS was associated with histology. The mean mRS pre-op was 1.6, post-op 1.5 and during follow-up 1.

Conclusion: In this large patient cohort of rare intraventricular tumors we demonstrate that long-term tumor control with good clinical outcome can be achieved by surgical resection despite the frequent involvement of essential neurovascular structures as implicated by the significant rate of transient morbidity. Overall the clinical course depends on the tumor type which is highly variable in the intraventricular location and very often preoperatively unclear.