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Vol. 15. Issue 2.
Pages 128-136 (January 2004)
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Vol. 15. Issue 2.
Pages 128-136 (January 2004)
Tratamiento del neurocitoma central. Experiencia en nuestro centro
Treatment of central neurocytoma. Experience at a single Institution
A. Rodríguez de Lope
, A. de La Lama, R. Martínez, C. Conde, F. de Prado, J.M. Otero
Servicio de Neurocirugía. Hospital Universitario Xeral-Cíes. Vigo
N. López-Ariztegui*, C. Fiaño**, F. Vázquez***
* Unidad de Neurología. Hospital Miguel Domínguez. Pontevedra
** Servicio de Anatomía Patológica. Hospital Universitario Xeral-Cíes. Vigo
*** Unidad de Resonancia Magnética. Hospital Universitario Xeral-Cíes. Vigo
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Resumen

El neurocitoma central se considera clásicamente una neoplasia benigna, de localización intraventricular, con diferenciación neuronal, derivada de las células precursoras de la matriz subventricular. Sin embargo algunos casos presentan comportamiento agresivo. El tratamiento de elección es la extirpación quirúrgica completa. Los tratamientos complementarios con radioterapia o quimioterapia se reservan para las recidivas o lesiones residuales. Revisamos la experiencia en nuestro centro con este tipo de lesiones.

Se intervinieron cinco pacientes con tumores intraventriculares en los cuales el diagnóstico histológico fue de neurocitoma. Todos los casos se revisaron de forma retrospectiva. En todos los tumores se realizó estudio de proliferación celular con Ki-67. Se consiguió una resección completa por vía transcortical en todos los pacientes excepto en uno en el que se administró radiocirugía al resto tumoral con importante reducción de la lesión. Todos los pacientes tenían un índice de proliferación menor del 2% excepto uno con el 5%. No hubo recidivas tumorales en el periodo de seguimiento que osciló entre 12 y 36 meses.

La resección quirúrgica completa de estas lesiones consigue un mejor control de la enfermedad y supervivencia que otros tratamientos. La radiocirugía como tratamiento complementario en resecciones incompletas puede eliminar la necesidad de reintervenciones y evitar los efectos secundarios a largo plazo de la radioterapia convencional.

Palabras clave:
Tumor cerebral
Neurocitoma
Tratamiento quirúrgico
Radiocirugia
Summary

Central neurocytomas are clasically considered as a rare, intraventricular benign tumours with neuronal differentiation derived from precursor cells of subventricular matrix. However some patients with neoplasms with histologic atypia and elevated proliferation poten-tial may have a poor outcome. Treatment of choice is complete surgical excision. Adjuvant therapy is reserved for patients with residual or recurrent lesions including reoperation, radiotherapy or chemotherapy. We review our experience with the treatment of this neoplasm.

Five patients with an intraventricular mass studied with magnetic resonance imaging underwent craniotomy for tumour resection. AU cases were reviewed retrospectively. Histopathological analysis conflrmed central neurocytoma in all cases. Proliferation index was assesed by Ki-67 inmunohistochemistry.

Complete radiological tumor resection through transcortical approach was achieved in all except one patient. In this case adjuvant therapy with radiosur-gery was given with important reduction in tumor size. All the tumours had a proliferation index below 2% except one with 5%. Follow-up in four patients ranged from 12 to 36 months. There were no tumour recurrenees in this period.

Complete surgical excision of central neurocytoma provides better local control and survival compared with other treatments. Radiosurgery as adjuvant therapy in incomplete resections may eliminate the need of reoperation and avoid long-term side efeets from conventional radiotherapy.

Key words:
Brain tumor
Neurocytoma
Surgical therapy
Radiosurgery

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