Twenty-nine patients met the enrollment criteria (Table 1). The average age of the patients was 31.93 years (range 17-61 years). There were 17 male patients (male: female = 1.4:1), the average preoperative KPS score was 88.62 ± 6.39, and the average maximum diameter of the tumor was 54.17 ± 15.62 mm, of which 23 patients (79.3%) had an average maximum diameter ≥ 5 cm. Twenty-seven patients (93.1%) achieved gross total tumor resection by imaging (as shown in Figure 1).
Table 1. Clinical characteristics, treatment and prognosis of 29 patients with CN
|
Total/average
|
Age
Male
KPS1
KPS2
KPS3
Large CN
Treatment
Gross total resection
Radiotherapy*
Postoperative complications
Hemiplegia
Aphasia
Epilepsy
Fever
Memory decline
V-P shunt
*Length of stay
Mean follow-up time
Tumor recurrence
|
29
31.93(17-61)
17(58.6%)
88.62±6.39
77.59±7.40
90.34±6.81
23(79.3%)
27(93.1%)
5(17.2%)
10(34.5%)
10(34.5%)
4(13.8%)
12(41.4%)
15(51.7%)
5(17.2%)
28.28±17.41
49.52±25.40
3(10.3%)
|
*One patient was hospitalized for 110 days, which was several times longer than that of the other patients. Radiotherapy*: indicates patients who received radiotherapy after primary surgery. KPS1: Preoperative KPS; KPS2: Discharge KPS; KPS3: KPS at the last follow-up.
Operation
Twenty-seven patients (93.1%) were treated by gross total tumor resection, and no operative deaths occurred. Among them, 27 patients underwent transcortical approach, and surgical approach through the trigone of the lateral ventricle was performed in 2 cases. Of the 23 patients with large central neurocytoma, 21 (91.3%) underwent gross total resection. All 6 patients with non-large central neurocytoma underwent total resection. However, there was no significant correlation between the degree of resection and the recurrence rate.
Postoperative complications
Ten patients (34.5%) had hemiplegia, aphasia (34.5%), epilepsy (13.8%), memory decline (51.7%) and fever (41.4%). Five patients (17.2%) with hydrocephalus underwent ventriculoperitoneal shunting. Among 23 patients with large central neurocytoma (Table 2), 10 (43.5%) had hemiplegia, 8 (34.8%) had aphasia, 4 (17.3%) had epilepsy, 9 (39.1%) had fever, and 3 (13.0%) underwent ventriculoperitoneal shunting for hydrocephalus. Hemiplegia occurred more frequently in patients with large central neurocytoma than in patients with non-large central neurocytoma (P = 0.046). However, there was no significant difference in the incidence of aphasia, epilepsy, fever, severe hydrocephalus or memory decline between the two groups. Moreover, memory decline was significantly correlated with radiotherapy (Table 3) (P=0.017).
Table 2. Comparison of treatment and prognosis between large CN and non-large CN
|
Large CN
|
Non-large CN
|
Chi square value
|
P value
|
Treatment
Extent of resection
Gross total resection
Subtotal resection
V-P shunt
Yes
No
Radiotherapy
Yes
No
Postoperative complications
Hemiplegia
Yes
No
Aphasia
Yes
No
Epilepsy
Yes
No
Fever
Yes
No
Memory decline
Yes
No
Recurrence
Yes
No
|
21
2
3
20
5
18
10
13
8
15
4
19
9
14
13
10
3
20
|
6
0
2
4
0
6
0
6
2
4
0
6
3
3
2
4
0
6
|
0.56
1.373
1.576
3.982
0.004
1.21
0.232
1.025
0.873
|
0.454
0.241
0.209
0.046
0.950
0.271
0.630
0.311
0.350
|
Table 3. Relationship between treatment and memory decline
|
Memory decline
|
Without memory decline
|
Chi-square value
|
P value
|
Gross total resection
Yes
No
V-P shunt
Yes
No
*Radiotherapy
Yes
No
|
13
2
3
12
7
8
|
14
0
2
12
1
13
|
2.005
0.166
5.663
|
0.157
0.684
0.017
|
*Including direct postoperative radiotherapy and re radiotherapy after recurrence
Postoperative radiotherapy and recurrence
Five patients (17.2%) received radiotherapy after the first operation, and none of the patients who received postoperative radiotherapy had tumor progression. Among the 24 patients who did not receive radiotherapy, 3 large central neurocytoma patients had tumor recurrence in the first year, the third year and the second year. The first patient received radiotherapy after the second operation, and the other two patients received radiotherapy directly. As of the last follow-up, there was no sign of tumor progression, and no deaths occurred. However, there was no significant statistical correlation between radiotherapy and the tumor recurrence rate (Table 4).
Table 4. Correlation between tumor recurrence and treatment
|
Recurrence
|
Non recurrence
|
Chi-square value
|
P value
|
Gross total resection
Yes
No
Radiotherapy
Yes
No
|
3
0
0
3
|
24
2
5
21
|
0.248
0.697
|
0.618
0.403
|
Average length of stay and KPS score
The average length of stay of the patients was 28.28 ± 17.41 days (12-110 days). The average KPS score of the patients at discharge was 77.59 ± 7.40. As of the last follow-up, the average KPS score was 90.34 ± 6.81. Except for one patient, who needs to be taken care of by his family, all the other patients can live and work independently and normally.