Clinicopathological spectrum of Intracranial Posterior Fossa Tumours and their Prognostic significance
A Retrospective Institutional study at tertiary care hospital of Nalgonda District
Keywords:
Intracranial Posterior fossa tumors, Cerebello-pontine angle, brainstem compression, Hydrocephalus.
Abstract
Background: Intracranial Posterior fossa tumors are critical brain lesions with significant neurological morbidity and mortality due to limited space and involvement of vital brain stem nuclei and fourth ventricle. Early diagnosis of posterior fossa tumors is vital to prevent potential risks of Brain stem compression, herniation, hydrocephalus and death. Aim of the study: 1. To study the morphological spectrum of intracranial posterior fossa SOLs. 2.To determine the frequency of posterior fossa SOLs reported in the tertiary care center of Nalgonda district. 3. To correlate clinical presentation with histopathological diagnosis and assess prognosis, and compare it with national and international literature. Materials and Methods: The present study was a retrospective description study conducted at the Department of pathology, Kamineni Institute of Medical Sciences, Narketpalli over a period of 3 years starting from June 2015 to June 2018. During this period, histopathological analysis of all the intracranial posterior cranial fossa tumors was done, correlated with clinical and radiological findings and prognosis assessed. Result: In our study Posterior fossa tumors are predominantly seen in adults with peak incidence in fourth decade. In children majority of the tumors were reported below 5 years of age. Most common presenting symptom was head ache and vomiting. Most common tumor was Medulloblastoma in children and Schwannoma in adults. Most common location was Cerebello-pontine angle followed by cerebellum. Recurrence rates were higher for CP angle tumors due to difficult sub-total resection. Prognosis is good for patients with total resection of tumors. Conclusion: Posterior fossa tumours are critical brain lesions with significant neurological morbidity and mortality. With rapid advancement in radiology and advent of modern therapeutic modalities early diagnosis and treatment is possible in many cases. Histopathology remains the gold standard in diagnosing Intracranial Posterior fossa tumours and necessary for the formulation of further management after neurosurgery.References
1. Al-Shatoury HAH, Galhom AA, Engelhard H. Posterior fossa tumors. Emedicine Neurosurgery 2008. Available from: https://emedicine.medscape. com/article/249495-overview.
2. Cushing H. Experience with the cerebellar medulloblastoma: critical review. Acta Pathol Microbiol Immunol Scand.1930;7:1-86.
3. Rehman AU, Lodhi S, Murad S. Morphological pattern of posterior cranial fossa tumors. Annals. 2009;15(2):51-57.
4. Zhou LF, Du G, Mao Y, Zhang R. Diagnosis and surgical treatment of brainstem hemangioblastomas. Surg Neurol. 2005 Apr. 63(4):307-15; discussion 315-6.
5. Zabek M. Primary posterior fossa tumours in adult patients. Folia Neuropathol. 2003. 41(4):231-6.
6. Lin CT, Riva-Cambrin JK. Management of posterior fossa tumours and hydrocephalus in children: a review. Childs Nerv Syst. 2015 Oct. 31 (10):1781-9.
7. Lam S, Reddy GD, Lin Y, Jea A. Management of hydrocephalus in children with posterior fossa tumours. Surg Neurol Int. 2015. 6 (Suppl 11): S346-8.
8. Le Fournier L, Delion M, Esvan M, De Carli E, Chappé C, Mercier P, et al. Management of hydrocephalus in pediatric metastatic tumours of the posterior fossa at presentation. Childs Nerv Syst. 2017 May 11.
9. Schijman E, Peter JC, Rekate HL, et al. Management of hydrocephalus in posterior fossa tumours: how, what, when. Childs Nerv Syst. 2004 Mar. 20(3):192-4.
10. Millard NE, De Braganca KC. Medulloblastoma. J Child Neurol. 2015 Sep 2.
11.Horisawa S, Nakano H, Kawamata T, Taira T. Novel Use of the Leksell Gamma Frame for Stereotactic Biopsy of Posterior Fossa Lesions: Technical Note. World Neurosurg. 2017 Jul 21.
12. Hamisch C, Kickingereder P, Fischer M, Simon T, Ruge MI. Update on the diagnostic value and safety of stereotactic biopsy for pediatric brainstem tumours: a systematic review and meta-analysis of 735 cases. J Neurosurg Pediatr. 2017 Sep. 20 (3):261-268.
13. Akay KM, Izci Y, Baysefer A, et al. Surgical outcomes of cerebellar tumours in children. Pediatr Neurosurg. 2004 Sep-Oct. 40(5):220-5.
14. Kalyani D, Rajyalakshmi S, Kumar OS. Clinicopathological study of posterior fossa intracranial lesions. J Med Allied Sci 2014;4(2):62-8.
15. Gollapalli SL, Moula MC, Shriram, et al. Spectrum of posterior cranial fossa space occupying lesions- our experience at a tertiary care centre. J. Evolution Med. Dent. Sci. 2018;7(36):4022-4026
16. Natarajan Meenakshisundaram, Balasubramanian Dhandapani. Posterior cranial Fossa space occupying lesions: an institutional experience. Int J Res Med Sci. 2018 Jul;6(7):2281-2284.
17. Priya VS, Kurien SS. Posterior cranial fossa lesions- a clinicopathological correlative study. J. Evolution Med. Dent. Sci. 2017;6(64):4666-4669.
18. Medulloblastoma in childhood-king Edward memorial hospital surgical experience and review: Comparative analysis of the case series of 365 patients. Muzumdar D, Deshpande A, Kumar R, Sharma A, Goel N, Journal of Pediatric Neurosciences.2011;6(3):78-85.
19 Pietsch T, Schmidt R, Remke M, Korshunov A, Hovestadt V, Jones DT. et al (2014) Prognostic Significance of clinical, histopathological and molecular characteristics of Medulloblastomas in the prospective HIT 2000 multicenter clinical trial cohort. Acta Neuropathol. 128(1):137-49.
20. Gjerris F, Klinken L. Long-term prognosis in children with benign cerebellar astrocytoma. J Neurosurg. 1978 Aug. 49(2):179-84.
21. Smith RR, Zimmerman RA, Packer RJ, et al. Pediatric brainstem glioma. Post-radiation clinical and MR follow-up. Neuroradiology. 1990. 32(4):265-71.
22. Wiestler OD, Schiffer D, Coons SW, Prayson RA, Rosenblum MK. Ependymal tumors: World Health Organization classification of tumors, Pathology and genetics – Tumors of the Nervous system Lyon, 2000, IARC press, PP 71-81.
23. Schiffer D, Chiò A, Giordana MT, et al. Histologic prognostic factors in ependymoma. Childs Nerv Syst 1991;7(4):177-82.
24. Boop FA Repeat surgery for residual ependymoma J Neurosurg Pediatr 8(3):244-5.
25. Massimino M, Solero CL, Garre ML, Biassoni V, Cama A Genitori L, et al. (2011) second look surgery for ependymoma the Italian experience. J Neurosurg pediatr 8(3):246-50.
26. Merchant TE, Li C, Xiong X, Kum LE, Boop FA, Sanford RA (2009). Conformal radiotherapy after surgery for Pediatric ependymoma, a prospective study. Lancet Oncol. 10(3): 256-66.
27. Salazar OM, Castro-Vita H, VanHoutte P, Rubin P, Aygun C, Improved survival in cases of intracranial ependymoma after radiation therapy. Late report and recommendations. J.Neurosurg. 1983;59:652-9.
28.Wolf JE, Sajedi M, Brant R, Copper MJ, Egeler RM. Choroid plexus tumors. Br J Cancer 87(10):1086-91.
29. Shenoy SN and Raja A. Cystic olfactory groove schwannoma. Neurology India 2004; 52(2):261-262.
30. Russels DS, Rubinstein LJ (1989) Pathology of Tumors of the Nervous system. London: Edward Arnold.
31. Velho V, Agarwal V, Mally R, et al. Posterior fossa meningioma “our experience” in 64 cases. Asian Journal of Neurosurgery 2012;7(3):116-24.
32. Helseth A, Mork SJ, Johansen A, et al. Neoplasms of the central nervous system in Norway. A population based epidemiological study of meningiomas. APMIS 1989;97(7):646–54.
33. Hur H, Jung S, Jung TY, et al. Cerebellar glioblastoma multiforme in an adult. Journal of Korean Neurosurgical Society 2008;43(4):194-7.
34. Pan J, Jabarkheel R, Huang Y, Ho A, Chang SD. Stereotactic radiosurgery for central nervous system hemangioblastoma: systematic review and meta-analysis. J Neurooncol. 2018;137:11–22.
2. Cushing H. Experience with the cerebellar medulloblastoma: critical review. Acta Pathol Microbiol Immunol Scand.1930;7:1-86.
3. Rehman AU, Lodhi S, Murad S. Morphological pattern of posterior cranial fossa tumors. Annals. 2009;15(2):51-57.
4. Zhou LF, Du G, Mao Y, Zhang R. Diagnosis and surgical treatment of brainstem hemangioblastomas. Surg Neurol. 2005 Apr. 63(4):307-15; discussion 315-6.
5. Zabek M. Primary posterior fossa tumours in adult patients. Folia Neuropathol. 2003. 41(4):231-6.
6. Lin CT, Riva-Cambrin JK. Management of posterior fossa tumours and hydrocephalus in children: a review. Childs Nerv Syst. 2015 Oct. 31 (10):1781-9.
7. Lam S, Reddy GD, Lin Y, Jea A. Management of hydrocephalus in children with posterior fossa tumours. Surg Neurol Int. 2015. 6 (Suppl 11): S346-8.
8. Le Fournier L, Delion M, Esvan M, De Carli E, Chappé C, Mercier P, et al. Management of hydrocephalus in pediatric metastatic tumours of the posterior fossa at presentation. Childs Nerv Syst. 2017 May 11.
9. Schijman E, Peter JC, Rekate HL, et al. Management of hydrocephalus in posterior fossa tumours: how, what, when. Childs Nerv Syst. 2004 Mar. 20(3):192-4.
10. Millard NE, De Braganca KC. Medulloblastoma. J Child Neurol. 2015 Sep 2.
11.Horisawa S, Nakano H, Kawamata T, Taira T. Novel Use of the Leksell Gamma Frame for Stereotactic Biopsy of Posterior Fossa Lesions: Technical Note. World Neurosurg. 2017 Jul 21.
12. Hamisch C, Kickingereder P, Fischer M, Simon T, Ruge MI. Update on the diagnostic value and safety of stereotactic biopsy for pediatric brainstem tumours: a systematic review and meta-analysis of 735 cases. J Neurosurg Pediatr. 2017 Sep. 20 (3):261-268.
13. Akay KM, Izci Y, Baysefer A, et al. Surgical outcomes of cerebellar tumours in children. Pediatr Neurosurg. 2004 Sep-Oct. 40(5):220-5.
14. Kalyani D, Rajyalakshmi S, Kumar OS. Clinicopathological study of posterior fossa intracranial lesions. J Med Allied Sci 2014;4(2):62-8.
15. Gollapalli SL, Moula MC, Shriram, et al. Spectrum of posterior cranial fossa space occupying lesions- our experience at a tertiary care centre. J. Evolution Med. Dent. Sci. 2018;7(36):4022-4026
16. Natarajan Meenakshisundaram, Balasubramanian Dhandapani. Posterior cranial Fossa space occupying lesions: an institutional experience. Int J Res Med Sci. 2018 Jul;6(7):2281-2284.
17. Priya VS, Kurien SS. Posterior cranial fossa lesions- a clinicopathological correlative study. J. Evolution Med. Dent. Sci. 2017;6(64):4666-4669.
18. Medulloblastoma in childhood-king Edward memorial hospital surgical experience and review: Comparative analysis of the case series of 365 patients. Muzumdar D, Deshpande A, Kumar R, Sharma A, Goel N, Journal of Pediatric Neurosciences.2011;6(3):78-85.
19 Pietsch T, Schmidt R, Remke M, Korshunov A, Hovestadt V, Jones DT. et al (2014) Prognostic Significance of clinical, histopathological and molecular characteristics of Medulloblastomas in the prospective HIT 2000 multicenter clinical trial cohort. Acta Neuropathol. 128(1):137-49.
20. Gjerris F, Klinken L. Long-term prognosis in children with benign cerebellar astrocytoma. J Neurosurg. 1978 Aug. 49(2):179-84.
21. Smith RR, Zimmerman RA, Packer RJ, et al. Pediatric brainstem glioma. Post-radiation clinical and MR follow-up. Neuroradiology. 1990. 32(4):265-71.
22. Wiestler OD, Schiffer D, Coons SW, Prayson RA, Rosenblum MK. Ependymal tumors: World Health Organization classification of tumors, Pathology and genetics – Tumors of the Nervous system Lyon, 2000, IARC press, PP 71-81.
23. Schiffer D, Chiò A, Giordana MT, et al. Histologic prognostic factors in ependymoma. Childs Nerv Syst 1991;7(4):177-82.
24. Boop FA Repeat surgery for residual ependymoma J Neurosurg Pediatr 8(3):244-5.
25. Massimino M, Solero CL, Garre ML, Biassoni V, Cama A Genitori L, et al. (2011) second look surgery for ependymoma the Italian experience. J Neurosurg pediatr 8(3):246-50.
26. Merchant TE, Li C, Xiong X, Kum LE, Boop FA, Sanford RA (2009). Conformal radiotherapy after surgery for Pediatric ependymoma, a prospective study. Lancet Oncol. 10(3): 256-66.
27. Salazar OM, Castro-Vita H, VanHoutte P, Rubin P, Aygun C, Improved survival in cases of intracranial ependymoma after radiation therapy. Late report and recommendations. J.Neurosurg. 1983;59:652-9.
28.Wolf JE, Sajedi M, Brant R, Copper MJ, Egeler RM. Choroid plexus tumors. Br J Cancer 87(10):1086-91.
29. Shenoy SN and Raja A. Cystic olfactory groove schwannoma. Neurology India 2004; 52(2):261-262.
30. Russels DS, Rubinstein LJ (1989) Pathology of Tumors of the Nervous system. London: Edward Arnold.
31. Velho V, Agarwal V, Mally R, et al. Posterior fossa meningioma “our experience” in 64 cases. Asian Journal of Neurosurgery 2012;7(3):116-24.
32. Helseth A, Mork SJ, Johansen A, et al. Neoplasms of the central nervous system in Norway. A population based epidemiological study of meningiomas. APMIS 1989;97(7):646–54.
33. Hur H, Jung S, Jung TY, et al. Cerebellar glioblastoma multiforme in an adult. Journal of Korean Neurosurgical Society 2008;43(4):194-7.
34. Pan J, Jabarkheel R, Huang Y, Ho A, Chang SD. Stereotactic radiosurgery for central nervous system hemangioblastoma: systematic review and meta-analysis. J Neurooncol. 2018;137:11–22.
Published
2019-10-01
Issue
Section
Original Article
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
