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Table of Contents
LETTER TO EDITOR
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 247-248

Authors' reply to: Pandrowala and Shaikh et al.


1 Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
2 Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, India

Date of Web Publication20-Dec-2019

Correspondence Address:
Phanithi Prakash Babu
F-71, Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad - 500 046, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_89_19

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How to cite this article:
Kirankumar C K, Deshpande RP, Chandrasekhar Y B, Panigrahi M, Babu PP. Authors' reply to: Pandrowala and Shaikh et al. Cancer Res Stat Treat 2019;2:247-8

How to cite this URL:
Kirankumar C K, Deshpande RP, Chandrasekhar Y B, Panigrahi M, Babu PP. Authors' reply to: Pandrowala and Shaikh et al. Cancer Res Stat Treat [serial online] 2019 [cited 2020 Sep 23];2:247-8. Available from: http://www.crstonline.com/text.asp?2019/2/2/247/273704



We acknowledge and appreciate the queries raised by Dr. Pandrowala[1] and Dr. Shaikh and Dr. Moiyadi[2] to our published study on ventricular tumors.[3],[4] We agree with the potential concerns and we would like to note that more critical work is needed for a better understanding of the surgical procedures of ventricular tumors, with the hope of translating to improved clinical course.

Dr. Pandrowala raises concern about the preference of surgical modality. In our approach to intraventricular tumors, we have used both endoscopy and open microscopic approaches as complimentary to each other rather than preferring one over the other approach. Endoscopic approach avoided permanent shunt placement in 88% of the patients, in which endoscopy was used, whereas pathological yield (diagnostic accuracy) was 100% in our view. Histopathology of the tumor which represents its growth potential for invasion/recurrence is one of the important factors predicting the outcome. We preferred using histopathology to compare the outcome. As our study period started before the new World Health Organization (WHO) nomenclature, we preferred to use the old WHO 2007 classification in our study. We used neuronavigation in some of the cases for planning craniotomy and approach to avoid venous and sinus injury. By using the endoscopic procedure to get the biopsy and histopathological diagnosis in some cases of intraventricular tumors, second major microneurosurgical procedure was avoided in low-grade nonprogressive and radiosensitive tumors.

We would like to clear the confusion regarding the total number of cases reflecting in the table. In patients with high-grade and progressive low-grade tumors, second microsurgical procedure was performed after the initial endoscopic procedure and biopsy of the lesion. Hence, the total number of procedures added up to 143.

Further, to reply to the question regarding the details of radiotherapy. Radiotherapy was given in the following situations:

  1. High-grade tumors
  2. If there is an increase in the residual tumor which was left behind due to adherence to vital structures in the postoperative imaging
  3. Radiosensitive tumors
  4. Evidence of recurrent tumors in the follow-up magnetic resonance imaging (MRI) scans.


In response to the questions raised by Dr. Shaikh and Dr. Moiyadi, we would like to explain that according to our experience and our philosophy of treating intraventricular tumor, we maintain that both microscopic and endoscopic approaches are complimentary to each other to achieve the best results.

In those patients who presented with acute symptoms such as unconsciousness, rapid deterioration of neurological status, and those patients who required immediate or permanent cerebrospinal fluid diversion, endoscopy was used. Endoscopy was also used when the radiology of the patients was suggestive of radiosensitive tumors having hydrocephalus and in small cystic tumors such as colloid cyst or neurocysticercosis cyst. In some patients as per the clinical need, endoscopic third ventriculostomy and biopsy were performed together.

If the tumor was radiosensitive, curative radiotherapy was administered. If the tumor was low grade and adherent to the brainstem, the patient was managed with observation with periodic MRI scans to observe for the growth in the size of the tumor. Only those patients who progressed on follow-up MRI and who had high-grade tumors underwent microscopic excision of the tumor.

We admire the critical comments and we agree that more work is needed for a better understanding of the ventricular tumors, aimed at improving the clinical course of treatment. We support all the attempts aimed at resolving the unanswered questions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pandrowala S. Clinical perspective in the management and outcomes of intraventricular tumors. Cancer Res Stat Treat 2019;2:246-7.  Back to cited text no. 1
  [Full text]  
2.
Shaikh S, Moiyadi A. Intraventricular tumors – A mixed bag. Cancer Res Stat Treat 2019;2:245-6.  Back to cited text no. 2
  [Full text]  
3.
Kriankumar CK, Deshpande RP, Chandrasekhar YB, Rao IS, Panigrahi M, Babu PP. Clinical management and prognostic outcome of intracranial ventricular tumors: A study of 134 cases. Cancer Res Stat Treat 2019;2:10-5.  Back to cited text no. 3
  [Full text]  
4.
Krishnatry R. Challenges in the management of intraventricular tumors in the current era. Cancer Res Stat Treat 2019;2:72-3.  Back to cited text no. 4
  [Full text]  




 

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