Central neurocytomas: Decision-making process of postoperative treatment. Lesson learned

Central neurocytoma is a rare intraventricular tumor with favorable prognosis following gross total resection (GTR). However, the role of Ki67-MIB1 values in the postoperative decision making-process of treatment, as well as the indication for adjuvant radiotherapy, remain debated. Medical record data of patients with confirmed diagnosis of central neurocytoma who underwent surgical resection at Department of Neurosurgery of "Ospedale del Mare" in Naples - Italy, between January and December 2022, were retrospectively reviewed. Inclusion criteria were adult patients (> 18 years old), minimum follow up 42 months, complete demographic, clinical, neuroradiological and histopathological data, type of management, complications and outcome, time to recurrence, follow-up duration. Five adult patients were enrolled according to the inclusion criteria. Most patients were women (80%), with mean age 24 years old. Main presenting symptoms were headache and visual deficit. Lesions always involved lateral ventricles, with extension to the third ventricle in all but one cases. Transcortical approach to the ipsilateral lateral ventricle with extension to the third ventricle was the main adopted surgical route. GTR was achieved in all cases without postoperative complications nor postoperative new onset neurological deficits. No patients required ventricular shunting procedures for hydrocephalus during the surveillance period. Follow-up ranged from 43 to 54 months. Ki67-MIB1 values ranged from 5% to 10%. No patients underwent adjuvant radiotherapy. Our findings suggest that GTR alone may be sufficient even in patients with moderately elevated Ki-67. A tailored, risk-adapted postoperative strategy is recommended rather than routine adjuvant treatment.