Skull Base Neurocytoma: Case Report and Review of the Literature of Extraventricular Neurocytomas

ABSTRACT

We report a rare skull base neurocytoma. A 44-year-old female with a history of focal seizure and progressive right-sided weakness sought treatment at an outside institution, where she underwent total resection of a ``left medial sphenoid wing paraganglioma'' in 1984. In 1995 after experiencing intense left-sided headaches for 3 weeks, the patient presented to our institution. Magnetic resonance imaging revealed a large local recurrence. She had deficits dating to her initial surgery, including moderate right-sided hemiparesis, complete left ophthalmoplegia, and left facial numbness.

The patient underwent a craniotomy with extensive removal of the involved sphenoid bone and a subtotal resection of the tumor. Neurocytoma was diagnosed based on strong immunohistochemical staining for synaptophysin and no reactivity for glial fibrillary acidic protein. Postoperatively, her headaches resolved completely and her neurologic status remained at baseline. The residual tumor was treated with radiation therapy. After 5 years, she remains clinically and radiographically stable.

Although typically located adjacent to the foramen of Monro, neurocytomas have now been reported in almost every subcompartment of the craniospinal axis. Finding neurocytomas in extraventricular locations may require revisiting the current theory that subependymal progenitor cells are the cells of origin for these tumors.

KEYWORDS

Brain neoplasm - extraventricular - neurocytoma - skull base

REFERENCES

• 1 Hassoun J, Gambarelli D, Grisoli F. Central neurocytoma. An electron-microscopic study of two cases.  Acta Neuropathol (Berl) . 1982;  56 151-156
• 2 Kleihues P, Burger P C, Scheithauer B W. The new WHO classification of brain tumors.  Brain Pathol . 1993;  3 255-268
• 3 Hassoun J, Soylemezoglu 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
• 4 Kim D G, Chi J G, Park S H. Intraventricular neurocytoma: clinicopathological analysis of seven cases.  J Neurosurg . 1992;  76 759-765
• 5 Hara A, Araki Y, Shinoda J. Central neurocytoma: proliferative assessment by nucleolar organizer region staining.  Surg Neurol . 1993;  39 343-347
• 6 Nishio S, Takeshita I, Kaneko Y, Fukui M. Cerebral neurocytoma. A new subset of benign neuronal tumours of the cerebrum.  Cancer . 1992;  70 529-537
• 7 Hessler R B, Lopes M BS, Frankfurter A, Reidy J, Vandenberg S R. Cytoskeletal immunohistochemistry of central neurocytomas.  Am J Surg Pathol . 1992;  16 1031-1038
• 8 Figarella-Branger D, Pellissier J F, Daumas Duport C. Central neurocytomas. Critical evaluation of a small cell neuronal tumor.  Am J Surg Pathol . 1992;  16 97-109
• 9 Yasargil M G, von Ammon K, von Deimling A, Valavanis A, Wichmann W, Wiestler O D. Central neurocytoma: histopathological variants and therapeutic approaches.  J Neurosurg . 1992;  76 32-37
• 10 Sgouros S, Jackowski A, Carey M P. Central neurocytoma without intraventricular extension.  Surg Neurol . 1994;  42 335-339
• 11 Coca S, Moreno M, Martos J A, Rodriguez J, Barcena A, Vaquero J. Case report: neurocytoma of spinal cord.  Acta Neuropathol . 1994;  87 537-540
• 12 Louis D N, Swearingen B, Linggood R M. Clinical study. Central nervous system neurocytoma and neuroblastoma in adults-report of eight cases.  J Neurooncol . 1990;  9 231-238
• 13 Stapleton S R, David K M, Harkness W FJ, Harding B N. Central neurocytoma of the cervical spinal cord [letter].  J Neurol Neurosurg Psych . 1997;  63 119
• 14 Stephan C L, Kepes J J, Arnold P, Green K D, Chamberlin F. Neurocytoma of the cauda equina: case report.  J Neurosurg Spine . 1999;  90 247-251
• 15 Hirschowitz L, Ansari A, Cahill D J, Bamford D S, Love S. Central neurocytoma arising within a mature cystic teratoma of the ovary.  Int J Gynecol Pathol . 1997;  16 176-179
• 16 Giangaspero F, Cenacchi G, Losi L, Cerasoli S, Bisceglia M, Burger P C. Extraventricular neoplasms with neurocytoma features.  Am J Surg Pathol . 1997;  21 206-212
• 17 Enam S, Rosenblum M, Ho K. Neurocytoma in the cerebellum.  J Neurosurg . 1997;  87 100-102
• 18 Sgouros S, Walsh A R, Barber P. Central neurocytoma of thalamic origin.  Br J Neurosurg . 1994;  8 373-376
• 19 Soontornniyomkij V, Schelper R L. Pontine neurocytoma.  J Clin Pathol . 1996;  49 764-765
• 20 Metcalf C, Mele E M, McAllister I. Neurocytoma of the retina.  Br J Ophthalmol . 1993;  77 382-384
• 21 von Deimling A, Kleihues P, Saremaslani P. Histogenesis and differentiation potential of central neurocytomas.  Lab Invest . 1991;  64 585-591
• 22 Nishio S, Takeshita I, Fukui M. Primary cerebral ganglioneurocytoma in an adult.  Cancer . 1990;  66 358-362
• 23 Alkhani A, Bilbao J, Medline P, Ogundimu F. Ganglioglioneurocytoma of the posterior fossa.  Can J Neurol Sci . 1999;  26 207-210
• 24 Miller D C, Kim R, Zagzag D. Neurocytomas: nonclassical sites and mixed elements [abstract].  J Neuropathol Exp Neurol . 1992;  51 364
• 25 Schweitzer J, Davies K. Differentiating central neurocytoma.  J Neurosurg . 1997;  86 534-546
• 26 Tatter S B, Borges L F, Louis D N. Central neurocytomas of the cervical spinal cord: report of two cases.  J Neurosurg . 1994;  81 288-293
• 27 Harada M, Morioka T, Nishio S, Fukui M. Neurocytoma in the left frontal lobe [in Japanese].  No Shinkei Geka . 1991;  19 89-92
• 28 Liebert W, Szymas J, Majewski T, Paprzycki W. Central neurocytoma of the right parietal and occipital lobe. Case report [in Polish].  Neurologia i Neurochirurgia Polska . 1998;  32 191-199