Primary Treatment for Central Neurocytoma
Maximal safe surgical resection is the primary treatment for central neurocytoma, with gross total resection (GTR) providing the best long-term tumor control and survival outcomes. 1, 2, 3
Surgical Approach
Complete surgical excision should be the goal whenever safely achievable, as GTR is the most important therapeutic modality and confers superior long-term outcomes compared to subtotal resection (STR). 1, 3
Surgical Technique Options
- Transcortical approach or interhemispheric transcallosal approach are both acceptable, with no significant differences in functional outcomes between the two methods. 3
- Endoscopic-assisted resection can be considered for select cases, particularly posterior third ventricle locations, offering a minimally invasive option that avoids craniotomy-related morbidity. 4
- Postoperative MRI with and without contrast should be obtained within 24-72 hours after surgery to document extent of resection. 5
Expected Outcomes
- GTR is achievable in approximately 54% of cases. 3
- The 5-year and 10-year overall survival rates are 93.3% and 85.4% respectively. 3
- The 5-year and 10-year progression-free rates are 73.4% and 57.5%. 3
Management After Incomplete Resection
For patients with subtotal resection or residual tumor, adjuvant radiotherapy should be considered to improve local tumor control, as the extent of resection significantly impacts progression-free survival. 1, 3
Radiation Options
- Stereotactic radiosurgery (SRS) is preferred for smaller residual tumor volumes or recurrences, providing safe and effective adjuvant therapy while avoiding long-term side effects of conventional radiotherapy in young patients. 6, 1
- Standard external beam radiotherapy can be added after STR, or radiation can be delayed until tumor progression occurs. 1
- Focused radiosurgery achieves complete response with tumor size reduction in recurrent cases. 6
Important Caveat
While complete radiographic tumor resection may be achieved initially, approximately 8-9% of patients experience tumor progression despite treatment, requiring long-term surveillance. 3
Role of Observation
Observation alone may be appropriate only after confirmed GTR, as central neurocytomas are WHO grade II tumors with a tendency to recur. 3 Serial MRI follow-up is essential, as local tumor progression can occur 9-25 months after initial surgery. 6
Limited Role of Chemotherapy
Chemotherapy is not considered a primary treatment modality for central neurocytoma. 2 It may be used as salvage therapy for recurrent tumors that cannot be resected and have already been radiated, though long-term responses have not been reported. 1