Clinical management and prognostic outcome of intracranial ventricular tumors: A study of 134 cases

Abstract

Introduction: Ventricular tumors are known to have a relatively rare occurrence and are underlined by complex pathophysiology. Methods: We retrospectively analyzed the clinicopathological details of 134 patients with intracranial ventricular lesions over a 5-year period. The patients were selected on the basis of diagnosed lesions by magnetic resonance imaging and further histopathology study. We have assessed the clinicopathological details from the database. Results: The median age of patients was 30 years (range: 1-73 years). In 47% of the cases, the lesions were located in the anterior third ventricle; glioma (n = 43) and colloidal cysts (n = 41) were the most common lesions. Presenting symptoms included seizures and features of hydrocephalus in 38.8% of patients. Open microsurgical (81.6%) and endoscopic (18.4%) surgery were performed. An open microsurgical approach was the main surgical treatment with operative mortality of 0.86% and permanent morbidity of 6.7%. Sixteen of the 27 patients in the endoscopic group underwent endoscopic third ventriculostomy (ETV) with biopsy. Survival was affected by the type of lesion. The progression-free survival was highest in the patients with neurocytoma and lowest in the patients with glioma (P = 0.01). Twenty-three patients received adjuvant radiation therapy. The decision regarding radiation therapy was made on the basis of individual lesion, histopathological type, and proliferative index. The mean overall survival was 34 months. Conclusions: Management of intraventricular tumors requires multimodality treatment including open microscopic surgery, neuroendoscopy, and radiation therapy as per the tumor pathology and hydrocephalus status. Simultaneous endoscopic biopsy with ETV can avoid major open surgery and mitigate the possible postsurgical complications.