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| LETTER TO EDITOR |
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| Year : 2019 | Volume
: 2
| Issue : 2 | Page : 245-246 |
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Intraventricular tumors - A mixed bag
Salman Shaikh, Aliasgar Moiyadi
Department of Surgical Oncology, Division of Neurosurgery, Tata Memorial Centre, Homi Bhabha National University, Mumbai, Maharashtra, India
| Date of Web Publication | 20-Dec-2019 |
Correspondence Address:
Aliasgar Moiyadi
1221, Homi Bhabha Block, Tata Memorial Centre, Mumbai, Maharashtra; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/CRST.CRST_68_19
How to cite this article:
Shaikh S, Moiyadi A. Intraventricular tumors - A mixed bag. Cancer Res Stat Treat 2019;2:245-6 |
Kirankumar et al.[1] have comprehensively described the clinicopathological features and outcomes of a large series of intraventricular tumors in this issue of the journal. The authors have described the pathologies and the surgical approaches and have correlated the data with progression-free survival and overall survival rates.
Whereas this is a very large series of cases from a leading tertiary care center, we would like to highlight certain issues to put the findings in perspective. As has been rightly pointed out in the editorial comment, a detailed description of the criteria applied for the surgical approaches, namely microsurgical or endoscopic (purely endoscopic or endoscopic assisted) is lacking.[2] This would help in better gauging of case selection while also giving an understanding of the surgical goals prior to excision. Neuroendoscopic biopsy has increased the rates of diagnostic accuracy to almost 90% of cases,[3] and the presence of hydrocephalus is no longer considered imperative for it to be successful. However, success rates and pathological diagnosis of biopsies in this series have not been mentioned in the paper. From [Table 2] in the article,[1] it seems that gliomas and colloid cysts made up almost all (85%) of cases. Hence, stratifying outcome measures by histopathology may not be very useful. Further, it may have been more informative to mention exact WHO terminologies for the large group of gliomas which could all behave very differently, especially the histone mutant midline glioma group. The authors could have also elaborated more on the site of origin of these gliomas. Of all gliomas, one would expect septal and the rare chordoid glioma of the third ventricle to be the truly intraventricular tumors, whereas most others can be really regarded as intraventricular extensions of parenchymal tumors at best.{Table 2}
Several adjuncts in neurosurgery help reduce the incidence of complications and to plan the surgery better, namely neuronavigation and diffusion tensor imaging (DTI). Intraoperative neuronavigation has been proven to help in localizing the access points and trajectory for intraventricular tumors,[4] whereas DTI can now help predict transgression of white matter while accessing the ventricles via the transcortical approach.[5] A note on the authors' preoperative evaluation protocol and use of such adjuncts would have been useful.
There are also some discrepancies in the reported numbers which need to be rectified. The results section mentions that biopsy was done in 16 of the 27 endoscopic cases, whereas [Table 4] mentions that biopsy was done in overall 12 cases. Furthermore, in the abstract, they mention that 23 cases received radiotherapy, but in the main text, they say that 37% received adjuvant therapy.{Table 4}
Overall, this paper gives an excellent overview of intraventricular tumors in relation to their pathologies and prognostic outcomes after offering multimodality approach encompassing microsurgical excision, endoscopic excision, and adjuvant radiation. A detailed description of the location of pathologies, preoperative radiological planning, intraoperative adjuncts, and pathological classification would have been a value addition to the knowledge shared by the authors.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Kriankumar CK, Deshpande RP, Chandrasekhar YK, 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.  [Full text] |
| 2. | Krishnatry R. Challenges in the management of intraventricular tumors in the current era. Cancer Res Stat Treat 2019;2:72-3. [Full text] |
| 3. | Rohde V, Behm T, Ludwig H, Wachter D. The role of neuronavigation in intracranial endoscopic procedures. Neurosurg Rev 2012;35:351-8. |
| 4. | García S, Rincon-Torroella J, Benet A, Oleaga L, González Sánchez JJ. Assessment of white matter transgression during neuroendoscopic procedures using diffusion tensor image fiber tracking. World Neurosurg 2017;99:232-40. |
| 5. | Constantini S, Mohanty A, Zymberg S, Cavalheiro S, Mallucci C, Hellwig D, et al. Safety and diagnostic accuracy of neuroendoscopic biopsies: An international multicenter study. J Neurosurg Pediatr 2013;11:704-9. |
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