Pathological findings and clinical course of midline paraventricular gliomas diagnosed using a neuroendoscope.

Pathological findings and clinical course of midline paraventricular gliomas diagnosed using a neuroendoscope.

World Neurosurg. 2018 Mar 09;:

Authors: Fukami S, Nakajima N, Okada H, Akimoto J, Miki T, Fukuhara H, Shishido-Hara Y, Nagao T, Tsuda M, Kohno M

Abstract
INTRODUCTION: Removal of midline paraventricular gliomas is difficult because of their deep localization and invasive character, requiring biopsy for pathological diagnosis. This study aimed to assess the pathological findings and clinical course of midline paraventricular gliomas diagnosed using a neuroendoscope.
METHODS: This study was performed as a retrospective investigation of 26 patients whose tumors were diagnosed as midline paraventricular gliomas using a neuroendoscope. The main loci of the lesions were the thalamus (11 cases), tectum (6 cases), and other areas (9 cases). Of these 26 patients, 21 (81%) were accompanied by obstructive hydrocephalus. Surgery was performed via the lateral ventricle using a flexible scope. For cases with obstructive hydrocephalus, we added endoscopic third ventriculostomy, septostomy, and/or plasty of the foramen of Monro. Pathological diagnosis was determined according to hematoxylin-eosin staining and immunohistochemistry using anti-GFAP, anti-Ki-67, anti-H3-K27M, and anti-IDH1-R132H antibodies.
RESULTS: The pathological diagnoses were grade I (5 cases), grade II (3 cases), grade III (6 cases), and grade IV (4 cases) gliomas. Six patients were diagnosed as having high-grade glioma, of which it was difficult to distinguish between grade III and grade IV. Two patients were undiagnosable. H3-K27M was strongly positive in 8 patients among 15 patients with high-grade glioma. All patients with high-grade gliomas died or received best supportive care within two years after surgery.
CONCLUSIONS: Neuroendoscopic surgery is useful for midline paraventricular gliomas in terms of the treatment of obstructive hydrocephalus, as well as pathological diagnosis and genetic analysis which are required under the WHO 2016 classification.

PMID: 29530692 [PubMed - as supplied by publisher]

http://ift.tt/2FFM33V