Open Access, Peer-reviewed
pISSN 2288-2405
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    Brain Tumor Res Treat. 2017 Apr;5(1):10-15. English.
    Published online Apr 30, 2017.
    https://doi.org/10.14791/btrt.2017.5.1.10
    Copyright © 2017 The Korean Brain Tumor Society, The Korean Society for Neuro-Oncology, and The Korean Society for Pediatric Neuro-Oncology
    Review

    Systematic Analysis of Clinical Outcomes Following Stereotactic Radiosurgery for Central Neurocytoma

    Timothy T. Bui,1 Carlito Lagman,1 Lawrance K. Chung,1 Stephen Tenn,2 Percy Lee,2,3 Robert K. Chin,2 Tania Kaprealian,1,2,3 and Isaac Yang1,2,3,4
      • 1Department of Neurosurgery, University of California, Los Angeles, CA, USA.
      • 2Department of Radiation Oncology, University of California, Los Angeles, CA, USA.
      • 3Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.
      • 4Department of Head and Neck Surgery, University of California, Los Angeles, CA, USA.
    • Correspondence: Isaac Yang. Departments of Neurosurgery, Radiation Oncology, University of California, Los Angeles, 300 Stein Plaza, Suite 562, Los Angeles, CA 90095-6901, USA. Tel: +1-310-794-5664, Fax: +1-310-825-9385, Email: iyang@mednet.ucla.edu
    Received February 01, 2017; Revised February 01, 2017; Accepted February 15, 2017.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Central neurocytoma (CN) typically presents as an intraventricular mass causing obstructive hydrocephalus. The first line of treatment is surgical resection with adjuvant conventional radiotherapy. Stereotactic radiosurgery (SRS) was proposed as an alternative therapy for CN because of its lower risk profile. The objective of this systematic analysis is to assess the efficacy of SRS for CN. A systematic analysis for CN treated with SRS was conducted in PubMed. Baseline patient characteristics and outcomes data were extracted. Heterogeneity and publication bias were also assessed. Univariate and multivariate linear regressions were used to test for correlations to the primary outcome: local control (LC). The estimated cumulative rate of LC was 92.2% (95% confidence interval: 86.5-95.7%, p<0.001). Mean follow-up time was 62.4 months (range 3-149 months). Heterogeneity and publication bias were insignificant. The univariate linear regression models for both mean tumor volume and mean dose were significantly correlated with improved LC (p<0.001). Our data suggests that SRS may be an effective and safe therapy for CN. However, the rarity of CN still limits the efficacy of a quantitative analysis. Future multi-institutional, randomized trials of CN patients should be considered to further elucidate this therapy.

    Keywords
    Brain tumors; Neurocytoma, central; Gamma Knife radiosurgery; Linear accelerators; Stereotactic radiosurgery

    INTRODUCTION

    Central neurocytoma (CN) is an extremely rare neuroepithelial tumor that accounts for 0.1–0.5% of all adult primary brain tumors [1, 2, 3, 4, 5]. CN is classified by the World Health Organization as a grade II (benign) neoplasm [3, 6]. By definition, CN is located in the ventricular system. As such, patients often present with headaches, nausea, or vomiting consistent with an obstructive pattern of hydrocephalus [3, 4, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17]. Computed tomography images demonstrate a heterogeneously hyperdense, enhancing mass. CN is typically isointense, iso-hyperintense and moderately hyperintense on T1-, T2-, and contrast enhanced magnetic resonance imaging, respectively[4, 8, 11, 15, 17, 18, 19, 20, 21].

    Management of CN involves surgical resection and/or adjuvant treatment consisting of radiotherapy or chemotherapy. Gross total resection (GTR) is often curative, with a 99% 5-year survival rate [4, 12, 22, 23, 24, 25]. However, due to its central location, GTR is rarely achieved (30% to 50% of cases) [26, 27]. Thus, subtotal resection (STR) with adjuvant treatment is often necessary [4, 12, 26, 28]. Adjuvant therapy for CN traditionally consisted of conventional radiotherapy, but was limited by associated cognitive deficits and other neurotoxicities [22, 27, 29, 30, 31, 32, 33]. Recently, stereotactic radiosurgery (SRS) is increasingly utilized as an alternative modality because of fewer fractions and associated toxicities [5, 22, 27, 31, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48]. Several studies have demonstrated equivalent tumor control and fewer complications with adjuvant SRS when compared with conventional radiotherapy [12, 49].

    A quantitative systematic review by Park and Steven [22] in 2012 (62 patients) demonstrated the efficacy of SRS for CN. The current systematic analysis updates the findings of Park and includes several additional case series published since then for a total of 150 patients [50, 51, 52, 53]. To our knowledge, this study represents the largest and most current review of CN patients treated with SRS.

    MATERIALS AND METHODS

    Search strategy

    Adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (http://www.prisma-statement.org) was maintained throughout this study. The PubMed database was searched by two independent authors using terms “CN” and “radiosurgery”. Abstracts were reviewed and screened against inclusion and exclusion criteria. Inclusion criteria were: 1) original data, 2) sufficient data on SRS outcomes for treatment of CN, and 3) more than one patient. Exclusion criteria were: 1) non-English text, 2) review articles, and 3) studies from the institutions/utilizing the same patient pool already included in analysis. Our screening process is summarized in Fig. 1.

    Fig. 1
    Flow chart of systematic search process.

    Statistical analysis

    Statistical analysis was performed using Comprehensive Meta-Analysis software (version 3.0; Biostat, Englewood, NJ, USA). The Q Statistic of the χ2 value test and inconsistency index was used to estimate heterogeneity of included studies. A random-effect model was chosen to better account for heterogeneity between included studies. A funnel plot, Begg's rank correlation test, and Egger's linear regression method were used to graphically and quantitatively assess publication bias. The summary of local control (LC) rate and 95% confidence interval (CI) were calculated from reported pooled data. Sensitivity analysis was done to see if any individual study significantly affected our results.

    Additional univariate and multivariate analyses were completed using the Statistical Analysis System (SAS, version 9.3; SAS Institute Inc., Cary, NC, USA). Linear regression of the overall data was used to test if various predictive variables were correlated with patient outcomes. Independent variables analyzed included mean tumor volume and dose. Data collated from individual articles was also analyzed using N-1 Pearson chi-squared tests to compare proportions [54, 55]. Statistical significance was set at a p-value less than 0.05.

    RESULTS

    A total of 10 studies (all case series) comprising 150 patients were included in our quantitative synthesis. These patients were treated with either Gamma Knife radiosurgery (GKRS; n=146, 97%) or linear accelerator radiosurgery (n=4, 3%) (Table 1). Resection (STR or GTR) was previously performed in 125 patients (83.3%), while 25 patients (16.7%) were treated with primary SRS. Mean marginal dose was 14.7 Gy (range 9–25 Gy). Mean tumor volume was 9.3 mL (range 0.4–36.4 mL). Complications included intracerebral (tumoral) hemorrhage (n=3), cerebral edema (n=3), and radiation injury (n=2). Overall survival was 98% at a mean follow-up of 62.4 months (range 3–149 months).

    Table 1
    Literature review of SRS for central neurocytoma

    Test of heterogeneity was non-significant (p=0.98). The Q-value was 2.53 (df=9) and I2=0. Publication bias was assessed graphically via funnel plot, which displays no significant asymmetry (Fig. 2). Begg's rank correlation test and Egger's linear regression method were both insignificant, with 2-tailed p-values of 0.09 and 0.93, respectively. Fig. 3 displays the control rates of all included studies. Overall LC was 92.2% (95% CI 86.5–95.7%) (p<0.001).

    Fig. 2
    Funnel plot of included studies showing asymmetry.

    Fig. 3
    Forest plot quantitative analysis of included studies.CI, confidence interval.

    Univariate linear regression models for both mean tumor volume and mean dose were significantly correlated with improved LC. Smaller tumor volumes were associated with better overall LC (p<0.001). Likewise, greater radiation doses correlated with better overall LC (p<0.001).

    DISCUSSION

    The optimal management of CN remains controversial [56]. Schild et al. [12] first reported the use of SRS for CN in 1997. Since then, multiple case series and systematic reviews have reaffirmed its efficacy [5, 22, 27, 31, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49]. The aforementioned study by Park and Steven [22] represents the first quantitative systematic review of SRS for treatment of CN. That study analyzed 5 retrospective case series (64 CNs in 62 patients). Of the 62 patients, only 4 displayed tumor growth after undergoing SRS (6.3%). We have analyzed 10 retrospective case series with a total of 150 patients, making this the largest review to date. Park and Steven [22] initially reported a LC rate of 91.1% with 2 local failures at a mean follow-up of 59.3 months. The expanded patient pool used in our study allowed us to calculate a similar LC rate (92.2%) reflecting 9 local failures at a mean follow-up of 62.4 months. Our data supports the conclusion that SRS is a viable treatment for CN.

    The two LC failures in Park and Steven's [22] initial review were associated with unknown etiology and inadequate dosing. In our analysis, individual data was available for 4 of the 9 LC failures. Mean marginal dose for local recurrences was 12.8 Gy compared to 15.6 Gy in 62 reported patients achieving tumor control. In addition, we found that mean dose was significantly correlated with LC. Despite the small sample size, this provides evidence that radiation dose could contribute to LC. Matsunaga et al. [5] reported improved LC with relatively low marginal doses of 13 to 18 Gy and therefore recommend a marginal dose of at least 13 Gy for effective tumor control. Our findings corroborate the recommendation of Matsunaga et al. [5] to maintain a dose high enough to achieve tumor control but not so high as to cause toxicity. This is largely consistent with the studies we reviewed, which have an overall mean dose of 14.7 Gy (range 10.5–17.0 Gy) (Table 1).

    MIB-1 (Ki-67) labeling index has been demonstrated to be the most important marker of potentially malignant behavior in CN [4, 56, 57, 58, 59, 60, 61, 62, 63, 64]. CN is considered atypical if the MIB-1 (Ki-67) labeling index is greater than or equal to 2% [4, 57, 58]. Interestingly, Genc et al. [56] reported that MIB-1 (Ki-67) indices had no significant effect on tumor response to SRS. However, the authors acknowledge that interpretation of their findings may be limited by a short follow-up duration (mean 36 months), particularly of atypical CNs. Data on MIB-1 (Ki-67) labeling index was not available for most studies, which prevented further analyses with regard to index and LC.

    SRS has been demonstrated to be effective in primary management of CN, particularly in cases less amenable to surgical resection [29, 31, 50]. In our study, 25 patients (16.7%) were treated with GKRS alone. Individual patient data was available for 18 patients. We found similar LC between primary SRS and our overall cohort (88.9% vs. 92.2%, p=0.63). Kim et al. [29] report a 20% LC failure rate for patients treated with primary SRS vs. 40% LC failure in patients treated with adjuvant SRS. Similarly, Karlsson et al. [50] found primary SRS to be efficacious in control of incidental, asymptomatic CN. The report of effective primary control is consistent with our findings that mean tumor volume is directly correlated with LC failure, since smaller tumor volumes are less likely to need surgical decompression or be symptomatic. Moreover, our data suggests that smaller tumor volume is significantly correlated with better LC.

    Radiation associated adverse events (AREs), defined as hyperintensity surrounding the treated lesion on imaging, are rare after SRS for CN (Table 1) [52]. There are only 3 reported AREs (all cases of cerebral edema) in the literature with only one becoming symptomatic (Table 1) [29, 41, 50]. Only 2% of the patients reviewed experienced AREs. Interestingly, Karlsson et al. [50] also reported that 45% (19/42) of their patients developed ventricular enlargement with 33% (1/3) requiring surgical management. This has not been reported elsewhere in the literature. Long term outcomes and toxicities of SRS for CN are not known. There have been two reported cases of increased MIB-1 (Ki-67) index, angiogenesis and glial differentiation in recurrent tumor that may have been attributable to SRS [5, 65]. Given the low complication rate and favorable tumor control, current dosages reported are considered both safe and effective, respectively.

    Limitations to this study were ever-present despite an increase in sample size (>two-fold) as compared to the prior quantitative systematic review. The rarity of CN makes available data sporadic, consisting of only case series. Mean follow-up for the included studies is another limitation, as a limited window can blind our results to potential failures occurring after end-of-study (Table 1).

    CONCLUSION

    Our data suggests that SRS may be an effective and safe therapy for CN. The rarity of CN limits the efficacy of a quantitative analysis. Future prospective, randomized studies with extended follow-up should be conducted to elucidate long-term efficacy of SRS in treatment of typical and atypical CN.

    Notes

    Conflicts of Interest:The authors have no financial conflicts of interest.

    Acknowledgments

    The authors thank Jason Sheehan, MD, PhD, University of Virginia School of Medicine, Michael B. Sisti, MD, FACS, Columbia University Medical Center, Richard C.E. Anderson, MD, FACS, FAAP, Columbia University Medical Center, Tony J.C. Wang, Columbia University Medical Center, Dong Gyu Kim, MD, PhD, Seoul National University College of Medicine, and Jin Wook Kim, MD, Seoul National University College of Medicine, for sharing their data.

    References

      1. Hassoun J, Gambarelli D, Grisoli F, et al. Central neurocytoma. An electron-microscopic study of two cases. Acta Neuropathol 1982;56:151–156.
      1. Sharma MC, Deb P, Sharma S, Sarkar C. Neurocytoma: a comprehensive review. Neurosurg Rev 2006;29:270–285.
        discussion 285.
      1. Yang I, Ung N, Chung LK, et al. Clinical manifestations of central neurocytoma. Neurosurg Clin N Am 2015;26:5–10.
      1. Choudhari KA, Kaliaperumal C, Jain A, et al. Central neurocytoma: a multi-disciplinary review. Br J Neurosurg 2009;23:585–595.
      1. Matsunaga S, Shuto T, Suenaga J, Inomori S, Fujino H. Gamma knife radiosurgery for central neurocytomas. Neurol Med Chir (Tokyo) 2010;50:107–112.
        disucussion 112-3.
      1. Louis DN, Ohgaki H, Wiestler OD, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97–109.
      1. Sharma MC, Sarkar C, Karak AK, Gaikwad S, Mahapatra AK, Mehta VS. Intraventricular neurocytoma: a clinicopathological study of 20 cases with review of the literature. J Clin Neurosci 1999;6:319–323.
      1. Jaiswal S, Vij M, Rajput D, et al. A clinicopathological, immunohistochemical and neuroradiological study of eight patients with central neurocytoma. J Clin Neurosci 2011;18:334–339.
      1. De Tommasi A, D'Urso PI, De Tommasi C, Sanguedolce F, Cimmino A, Ciappetta P. Central neurocytoma: two case reports and review of the literature. Neurosurg Rev 2006;29:339–347.
      1. Ashkan K, Casey AT, D'Arrigo C, Harkness WF, Thomas DG. Benign central neurocytoma. Cancer 2000;89:1111–1120.
      1. Chandrashekhar TN, Mahadevan A, Vani S, et al. Pathological spectrum of neuronal/glioneuronal tumors from a tertiary referral neurological institute. Neuropathology 2012;32:1–12.
      1. Schild SE, Scheithauer BW, Haddock MG, et al. Central neurocytomas. Cancer 1997;79:790–795.
      1. Agranovich AL, Ang LC, Fryer CJ. Central neurocytoma: report of 2 cases and literature review. J Neurooncol 1993;16:47–53.
      1. Brat DJ, Scheithauer BW, Eberhart CG, Burger PC. Extraventricular neurocytomas: pathologic features and clinical outcome. Am J Surg Pathol 2001;25:1252–1260.
      1. Hassoun J, Söylemezoglu F, Gambarelli D, Figarella-Branger D, von Ammon K, Kleihues P. Central neurocytoma: a synopsis of clinical and histological features. Brain Pathol 1993;3:297–306.
      1. Moussa R, Abadjian G, Nader M, et al. [Central neurocytoma. Four patients]. Neurochirurgie 2004;50:639–646.
      1. Shin JH, Lee HK, Khang SK, et al. Neuronal tumors of the central nervous system: radiologic findings and pathologic correlation. Radiographics 2002;22:1177–1189.
      1. Donoho D, Zada G. Imaging of central neurocytomas. Neurosurg Clin N Am 2015;26:11–19.
      1. Goergen SK, Gonzales MF, McLean CA. Interventricular neurocytoma: radiologic features and review of the literature. Radiology 1992;182:787–792.
      1. Schmidt MH, Gottfried ON, von Koch CS, Chang SM, McDermott MW. Central neurocytoma: a review. J Neurooncol 2004;66:377–384.
      1. Chen H, Zhou R, Liu J, Tang J. Central neurocytoma. J Clin Neurosci 2012;19:849–853.
      1. Park HK, Steven DC. Stereotactic radiosurgery for central neurocytoma: a quantitative systematic review. J Neurooncol 2012;108:115–121.
      1. Rades D, Fehlauer F. Treatment options for central neurocytoma. Neurology 2002;59:1268–1270.
      1. Paek SH, Kim DG, Kim IH, et al. O-22-327-Central neurocytoma: the role of radiation therapy and long-term outcome. Clin Neurol Neurosurg 1997;99 Supplement 1:S192.
      1. Bertalanffy A, Roessler K, Koperek O, Gelpi E, Prayer D, Knosp E. Recurrent central neurocytomas. Cancer 2005;104:135–142.
      1. Kim DG, Paek SH, Kim IH, et al. Central neurocytoma: the role of radiation therapy and long term outcome. Cancer 1997;79:1995–2002.
      1. Anderson RC, Elder JB, Parsa AT, Issacson SR, Sisti MB. Radiosurgery for the treatment of recurrent central neurocytomas. Neurosurgery 2001;48:1231–1237.
        discussion 1237-8.
      1. Leenstra JL, Rodriguez FJ, Frechette CM, et al. Central neurocytoma: management recommendations based on a 35-year experience. Int J Radiat Oncol Biol Phys 2007;67:1145–1154.
      1. Kim JW, Kim DG, Chung HT, et al. Radiosurgery for central neurocytoma: long-term outcome and failure pattern. J Neurooncol 2013;115:505–511.
      1. Chen YD, Li WB, Feng J, Qiu XG. Long-term outcomes of adjuvant radiotherapy after surgical resection of central neurocytoma. Radiat Oncol 2014;9:242.
      1. Chen MC, Pan DH, Chung WY, et al. Gamma knife radiosurgery for central neurocytoma: retrospective analysis of fourteen cases with a median follow-up period of sixty-five months. Stereotact Funct Neurosurg 2011;89:185–193.
      1. Maiuri F, Spaziante R, De Caro ML, Cappabianca P, Giamundo A, Iaconetta G. Central neurocytoma: clinico-pathological study of 5 cases and review of the literature. Clin Neurol Neurosurg 1995;97:219–228.
      1. Paek SH, Han JH, Kim JW, et al. Long-term outcome of conventional radiation therapy for central neurocytoma. J Neurooncol 2008;90:25–30.
      1. Bertalanffy A, Roessler K, Dietrich W, et al. Gamma knife radiosurgery of recurrent central neurocytomas: a preliminary report. J Neurol Neurosurg Psychiatry 2001;70:489–493.
      1. Cobery ST, Noren G, Friehs GM, et al. Gamma knife surgery for treatment of central neurocytomas. Report of four cases. J Neurosurg 2001;94:327–330.
      1. Pollock BE, Stafford SL. Stereotactic radiosurgery for recurrent central neurocytoma: case report. Neurosurgery 2001;48:441–443.
      1. Tyler-Kabara E, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for residual neurocytoma. Report of four cases. J Neurosurg 2001;95:879–882.
      1. Hara M, Aoyagi M, Yamamoto M, et al. Rapid shrinkage of remnant central neurocytoma after gamma knife radiosurgery: a case report. J Neurooncol 2003;62:269–273.
      1. Javedan SP, Manwaring K, Smith KA. Treatment of posterior third ventricular central neurocytoma with endoscopic biopsy, endoscopic third ventriculostomy and stereotactic radiosurgery. Minim Invasive Neurosurg 2003;46:165–168.
      1. Kim CY, Paek SH, Kim DG. Linear accelerator radiosurgery for central neurocytoma: a case report. J Neurooncol 2003;61:249–254.
      1. Martín JM, Katati M, López E, et al. Linear accelerator radiosurgery in treatment of central neurocytomas. Acta Neurochir (Wien) 2003;145:749–754.
        discussion 754.
      1. Suh JH, Barnett GH. Stereotactic radiosurgery for brain tumors in pediatric patients. Technol Cancer Res Treat 2003;2:141–146.
      1. Knisely JP, Linskey ME. Less common indications for stereotactic radiosurgery or fractionated radiotherapy for patients with benign brain tumors. Neurosurg Clin N Am 2006;17:149–167. vii.
      1. Rades D, Schild SE. Value of postoperative stereotactic radiosurgery and conventional radiotherapy for incompletely resected typical neurocytomas. Cancer 2006;106:1140–1143.
      1. Kim CY, Paek SH, Jeong SS, et al. Gamma knife radiosurgery for central neurocytoma: primary and secondary treatment. Cancer 2007;110:2276–2284.
      1. Yen CP, Sheehan J, Patterson G, Steiner L. Gamma knife surgery for neurocytoma. J Neurosurg 2007;107:7–12.
      1. González SV, Rozos AP, Farpón RC, Barceló AR, Fardoun HF, Sánchez MVV. Recidivant central neurocytoma treated with radiosurgery: a case report. J Radiother Pract 2012;11:120–126.
      1. Barnett GH, Linskey ME, Adler JR, et al. Stereotactic radiosurgery--an organized neurosurgery-sanctioned definition. J Neurosurg 2007;106:1–5.
      1. Patel DM, Schmidt RF, Liu JK. Update on the diagnosis, pathogenesis, and treatment strategies for central neurocytoma. J Clin Neurosci 2013;20:1193–1199.
      1. Karlsson B, Guo WY, Kejia T, et al. Gamma knife surgery for central neurocytomas. J Neurosurg 2012;117 Suppl:96–101.
      1. Kim JW, Kim WC, Cho JH, et al. A multimodal approach including craniospinal irradiation improves the treatment outcome of high-risk intracranial nongerminomatous germ cell tumors. Int J Radiat Oncol Biol Phys 2012;84:625–631.
      1. Monaco EA 3rd, Niranjan A, Lunsford LD. The management of central neurocytoma: radiosurgery. Neurosurg Clin N Am 2015;26:37–44.
      1. Yamanaka K, Iwai Y, Shuto T, et al. Treatment results of gamma knife radiosurgery for central neurocytoma: report of a Japanese multi-institutional cooperative study. World Neurosurg 2016;90:300–305.
      1. Campbell I. Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations. Stat Med 2007;26:3661–3675.
      1. Richardson JT. The analysis of 2×2 contingency tables--yet again. Stat Med 2011;30:890.
        author reply 891-2.
      1. Genc A, Bozkurt SU, Karabagli P, et al. Gamma knife radiosurgery for cranial neurocytomas. J Neurooncol 2011;105:647–657.
      1. Sharma MC, Rathore A, Karak AK, Sarkar C. A study of proliferative markers in central neurocytoma. Pathology 1998;30:355–359.
      1. Söylemezoglu F, Scheithauer BW, Esteve J, Kleihues P. Atypical central neurocytoma. J Neuropathol Exp Neurol 1997;56:551–556.
      1. Mackenzie IR. Central neurocytoma: histologic atypia, proliferation potential, and clinical outcome. Cancer 1999;85:1606–1610.
      1. Chen CL, Shen CC, Wang J, Lu CH, Lee HT. Central neurocytoma: a clinical, radiological and pathological study of nine cases. Clin Neurol Neurosurg 2008;110:129–136.
      1. Vajrala G, Jain PK, Surana S, Madigubba S, Immaneni SR, Panigrahi MK. Atypical neurocytoma: dilemma in diagnosis and management. Surg Neurol Int 2014;5:183.
      1. Cook DJ, Christie SD, Macaulay RJ, Rheaume DE, Holness RO. Fourth ventricular neurocytoma: case report and review of the literature. Can J Neurol Sci 2004;31:558–564.
      1. Eng DY, DeMonte F, Ginsberg L, Fuller GN, Jaeckle K. Craniospinal dissemination of central neurocytoma. Report of two cases. J Neurosurg 1997;86:547–552.
      1. Mozes P, Szanto E, Tiszlavicz L, et al. Clinical course of central neurocytoma with malignant transformation-an indication for craniospinal irradiation. Pathol Oncol Res 2014;20:319–325.
      1. Tanaka H, Sasayama T, Yamashita H, et al. Rapid tumor growth with glial differentiation of central neurocytoma after stereotactic radiosurgery. J Clin Neurosci 2016;31:188–192.
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    MeSH Terms
    Brain Neoplasms
    Follow-Up Studies
    Humans
    Hydrocephalus
    Linear Models
    Neurocytoma*
    Particle Accelerators
    Population Characteristics
    Publication Bias
    Radiosurgery*
    Radiotherapy
    Tumor Burden
    Metrics
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