Dissemination Patterns and Short-Term Management of Multifocal Rosette-Forming Glioneuronal Tumors

• Published in: World neurosurgery 2021-05, Vol.149, p.86-93
• Main Authors: Hockman, Jakob T., El Tecle, Najib E., Urquiaga, Jorge F., Alexopoulos, Georgios, Guzman, Miguel A., Coppens, Jeroen
• Format: Article
• Language: English
• Subjects: Dissemination; Management; Multifocal; Prognosis; Rosette-forming glioneuronal tumor; Satellitosis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2021.02.043

Multifocal rosette-forming glioneuronal tumors (RGNTs) are challenging to manage. Gross total resection is often impossible, and data on adjunctive therapies are limited. We reviewed cases of multifocal RGNTs in the literature with special focus on dissemination patterns and management. A literature review was conducted using PubMed and the key words “(multifocal OR multicentric OR satellite OR dissemination) AND glioneuronal.” There were 21 cases of multifocal RGNTs identified. Follow-up was available in 18 cases at a median of 17 months. Progression-free survival and overall survival at 1 year were 84% and 94%, respectively. Of all cases, 43% had cerebrospinal fluid (CSF) dissemination, 48% had intraparenchymal spread, and 10% had both. The presence of CSF dissemination led to palliative care and/or death in 20% of cases (n = 2). None of the cases with intraparenchymal spread progressed. Radiotherapy was used in 50% of cases with CSF dissemination, chemotherapy was used in 20%, and CSF shunting was used in 36%. No tumors with intraparenchymal spread required adjunctive therapy or shunting. RGNTs with CSF dissemination are more likely to behave aggressively, and early adjunctive therapies should be discussed with patients. Tumors with intraparenchymal spread grow slowly, and maximal safe resection followed by observation is likely sufficient in the short term. Long-term behavior of multifocal RGNTs is still unclear.