title: Endoscopy-verified occult subependymal dissemination of glioblastoma and brain metastasis undetected by MRI: prognostic significance.
abstract: Although various prognostic indices exist for patients with malignant brain tumors, the prognostic significance of the subependymal spread of intracranial tumors is still a matter of debate. In this paper, we report the cases of two intraventricular lesions, a recurrent glioblastoma multiforme (GBM) and a brain metastasis, each successfully treated with a neuroendoscopic approach. Thanks to this minimally invasive approach, we achieved good therapeutic results: we obtained a histological diagnosis; we controlled intracranial hypertension by treating the associated hydrocephalus and, above all, compared with a microsurgical approach, we reduced the risks related to dissection and brain retraction. Moreover, in both cases, neuroendoscopy enabled us to identify an initial, precocious subependymal tumor spreading below the threshold of magnetic resonance imaging (MRI) detection. This finding, undetected in pre-operative MRI scans, was then evident during follow-up neuroimaging studies. In light of these data, a neuroendoscopic approach might play a leading role in better defining the prognosis and optimally tailored management protocols for GBM and brain metastasis.
authors.affiliation: Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iacoangeli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Rienzo
authors.forename: Roberto
authors.initials: R
authors.lastname: Colasanti
authors.forename: Antonio
authors.initials: A
authors.lastname: Zizzi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gladi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Alvaro
authors.forename: Niccolò
authors.initials: N
authors.lastname: Nocchi
authors.forename: Lucia Giovanna Maria
authors.initials: LG
authors.lastname: Di Somma
authors.forename: Marina
authors.initials: M
authors.lastname: Scarpelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Scerrati