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PURPOSE: Brain tumors constitute 15–20% of all childhood cancers, whereas infratentorial brain tumors make up around 60–75% of all intracranial tumors. Surgical resection of infratentorial pediatric brain tumors carries a cumulative morbidity risk of up to 30%. We aimed to retrospectively review and analyze the clinical and functional outcomes of all infratentorial brain tumors where resections had been performed at a tertiary care hospital in Karachi Pakistan, for 10 years. METHODS: It was a retrospective cohort study, conducted at the Aga Khan University Hospital. All patients aged 0–18 years, who underwent resection for infratentorial brain tumors between January 2009 and December 2019 were analysed. The patients were identified using ICD-10 codes, and files were then reviewed for demographics, clinical presentations, details of the surgery, pre-operative and post-operative functional status, and different complications. MRI scans of patients were reviewed from the online hospital management system. Lansky's score was used to record functional status. Patients with incomplete medical records were excluded. RESULTS: Ninety-two children were included in the study. The median age was 6 years (IQR: 4–12 years), out of which 55 (59.8%) were male and 37 (40.2%) were female patients. Most common presenting complaint was headache (n = 68, 73.9%). The fourth ventricle was the most common location (43; 46.7%), and the majority of patients had medulloblastoma on histopathology (36; 39.1%). Gross total resection was achieved in 41 (44.6%) cases, followed by maximum safe resection in 28 (30.4%) cases, whereas 23 (25%) patients only had a biopsy. The mean post-op Lansky score (65.76) was better than the mean pre-op Lansky score (55.76) by 10 points and this difference was statistically significant 90% residual) were associated with poor outcomes (p = 0.014). CONCLUSION: Most of our patients had significant improvement in functional status after surgery, however, a patient who had deterioration in functional status were those who has the significant residual disease after surgery.

Objective: To identify symptoms and risk factors and promptly diagnose, treat, and manage pituitary adenomas. Prioritizing care for pituitary adenomas will reduce the prolonged disability. Methods: Patients with a histopathological diagnosis of a pituitary adenoma that presented at 32 tertiary care neurosurgical centres were included. The information recorded included demographics, treatment methods, adjuvant chemoradiotherapy and loss to follow-up. Data on tumour size, functionality, and laterality were collected. Results: Of the 32 hospitals surveyed, 24 operated on pituitary adenomas, and treated 277 patients. The mean age at diagnosis was 39.8 ± 13 years, with a majority of males (63.5%) being diagnosed than females. Paediatric cases constituted only 4.7% of the total pituitary adenomas operated upon. Gross total resection was reported for 155 (56%) of all pituitary adenoma patients. Majority of the patients affected by pituitary adenomas (80.1%) were from the working class. Conclusion: Highlighting care for non-malignant brain tumours is important for Pakistan's health system. Evidence pertaining to gender and age disparities indicates that males in the younger age groups are predominantly affected, which takes a large socio-economic toll on patients and their households. This study also highlights the need to incorporate digital health technologies for postoperative follow-up and adjuvant treatment. Keywords: Pituitary Neoplasms, Chemoradiotherapy, Healthcare, Socioeconomic Factors, Demography. Continue...

Objective: To quantify the metastatic brain tumour burden presenting to tertiary care neurosurgical centres, the demographics and mortality rate, and the type of metastatic tumours commonly presenting to neurosurgical practice. Methods: A cross-section retrospective study was conducted on patients diagnosed with brain tumours from 32 neurosurgical centres across Pakistan between January 1, 2019, to December 31, 2019. At least one neurosurgical resident and one neurosurgical faculty member were recruited from each centre as members of the Pakistan Brain tumour consortium. Mean with standard deviation or median with interquartile range was reported as variables. Results: Of 2750 patients in this cohort, 77 (2.8%) were diagnosed with metastatic brain tumours. The median age of these patients was 52 (IQR= 43-60) years; 9 (14%) adults were aged 20-39 years, 37 (57%) were aged 40-59, and 19 (29%) were aged 60 and above. There were 62 (82.7%) married patients with 4% unmarried. The median KPS score both pre and post-surgery was 80 (IQR= 60-90, 70-90 respectively), and 43 (55.8%) patients were lost to follow-up. The mortality rate for patients that followed up was 50%, 17 patients were alive, and 17 were deceased at the end of the study period. The 30-day mortality rate amongst our patients was 11.8% (n=4). Conclusion: The number of patients presenting to neurosurgical care with brain metastases is much lower than the expected incidence of metastatic brain lesions. Multidisciplinary integration and the establishment of a registry to track patients diagnosed with brain tumours is the first step in ensuring better care for these patients. Keywords: Brain Metastases, Epidemiology, LMIC, Neuro-oncological surgery, Continue....

Objective: To identify populations at risk for lost to follow-up while undergoing management of brain tumours in a low-resource setting. Methods: A retrospective study was conducted at the neurosurgical centre on patients presenting with a brain tumour from January 1, 2019, to December 31, 2019. Data on demographic characteristics, surgical characteristics, treatment, and outcomes such as mortality status, were collected by manual chart review. LTFU was defined as patients discontinuing clinical follow-up at the institute of surgical consultation within two years from the initial visit. Univariate (odds ratio) and multivariate (b-coefficient) logistic regression were used to determine factors' significance for LTFU. Results: From a total of 2750 patients from 32 centres, 1140 (41.4%) were LTFU during the study period. Of these 1140 LTFU patients, 156 (13.7%) were LTFU without any intervention, 984 (86.3%) were LTFU after the primary surgery, and 872 (76.5%) patients were LTFU without any adjuvant treatment. On univariate analysis annual hospital case volume (p< 0.001), older age group (15-39 years (p=0.037) and ?40 years (p= 0.016)), and non-surgical treatment (p

Objective: To provide information about brain tumour epidemiology in Pakistan and potential associated risk factors due to family, medical and social characteristics. Methods: A retrospective cross-sectional nationwide study was designed by the Pakistan Society of Neuro-oncology, to include patients diagnosed with brain tumours in Pakistan retrospectively, from January 1, 2019- December 31, 2019. The study intended to involve data from all age groups for all brain tumour cases, irrespective of histopathology which would determine the national prevalence and incidence of these tumours. Results: A total of 2750 brain tumour cases were recorded, of which 1897 (69%) were diagnosed in the public sector. MRIs were a more common radiological study compared to CT scans. Gliomas were the most common tumours 778 (28.29%), while pineal tumours were the least common 19 (0.69%). The median age at diagnosis for males was 36 (24-49), while the median age at diagnosis for females was 37 (24-48). Hypertension was the most common co-morbidity in patients diagnosed with a brain tumour, 524 (51.89%), and smoking was the most frequent social behaviour, 355 (62.02%). Findings indicate a low metastasis frequency and few females seeking care. Conclusion: The PBTES and the PBTC have presented an opportunity and platform for hospitals and health professionals to work together to strengthen cancer care health systems, ensure implementation of treatment guidelines and conduct regular cancer registration. Keywords: brain neoplasms, registries, retrospective studies, epidemiology, Neuro-oncological surgery. Continue...

Low- and middle-income countries sustain the majority of pediatric cancer burden, with significantly poorer survival rates compared to high-income countries. Collaboration between institutions in low- and middle-income countries and high-income countries is one of the ways to improve cancer outcomes.Patient characteristics and effects of a pediatric neuro-oncology twinning program between the Hospital for Sick Children in Toronto, Canada and several hospitals in Karachi, Pakistan over 7 years are described in this article.A total of 460 patients were included in the study. The most common primary central nervous system tumors were low-grade gliomas (26.7%), followed by medulloblastomas (18%), high-grade gliomas (15%), ependymomas (11%), and craniopharyngiomas (11.7%). Changes to the proposed management plans were made in consultation with expert physicians from the Hospital for Sick Children in Toronto, Canada. On average, 24% of the discussed cases required a change in the original management plan over the course of the twinning program. However, a decreasing trend in change in management plans was observed, from 36% during the first 3.5 years to 16% in the last 3 years. This program also led to the launch of a national pediatric neuro-oncology telemedicine program in Pakistan.Multidisciplinary and collaborative efforts by experts from across the world have aided in the correct diagnosis and treatment of children with brain tumors and helped establish local treatment protocols. This experience may be a model for other low- and middle-income countries that are planning on creating similar programs.

Background: The coronavirus disease-19 pandemic has aggravated the already neglected neurosurgical specialty in developing countries with a mounting shortage of specialists, long queues of operative patients, and a lack of adequate critical care units. Methods: We have reviewed the innovative strategies adopted for maintaining an optimal surgical practice while ensuring team safety at the Aga Khan University Hospital, Karachi Pakistan. Results: There is already a scarcity of resources in developing countries. The international guidelines had to be tailored to the context of the developing world. A multimodal strategy that focused on infection control, continuum of care, and the well-being of staff was adopted at Aga Khan University. Patients were screened and seen either in person or through telemedicine, depending on the severity of the disease. All educational activities for residents were shifted online, and this helped in preventing overcrowding. Conclusion: Optimal surgical practice while ensuring team safety can be achieved through a multimodal strategy focusing on infection control, continuum of care, and the well-being of staff.

Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute. Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis. Results: The mean age of our cohort was 8.6 years (range 3–15). There were 11 (61.1%) males and 7 (38.9%) females. There were 16 (88.9%) patients with diffuse intrinsic pontine gliomas (DIPGs), 1 (5.6%) patients with exophytic medullary gliomas, and 1 (5.6%) patient with midbrain/tectal glioma. Mean overall survival (OS) was 9.7 months. Mean progression-free survival (PFS) was 6.3 months. All patients with DIPG eventually passed away from their disease. Patients with DIPG who received radiotherapy had a longer OS and PFS than those who did not (9.8 and 6 months vs. 3.4 and 2.4 months). Diagnostic latency >1 month was found to have a statistically significant longer progression-free interval. Conclusion: DIPGs in the pediatric population have a poor prognosis. Radiotherapy serves to increase survival time but is not curative.

In recent years, reports from developed countries have shown that awake craniotomy has been shown to improve outcomes of surgical resection of brain tumors. However, no such data is available from low- and middle-income countries. We retrospectively reviewed 200 cases of awake craniotomy performed at our center for excision of brain tumors during last 5 years, and assessed clinical outcomes. Data was collected from patients’ medical records, and included demographics, tumor location/histology, clinical complains, and functional status. We used Karnofsky performance scale (KPS) to assess function. Extent of resection was determined on post-operative MRI. Statistical analysis was done using SPSS version 22. Seven attending surgeons performed these cases; however, 168 (84%) surgeries were performed by a single surgeon who is the senior author (SA Enam). Mean age was 39.3 ± 11.9 years and 79% (158) were male. Left frontal lobe was the most common location for tumors (50; 25%). Although 52% (104) patients had malignant neoplasms, seizures were the most common presenting symptom in 63% (126) cases followed by motor deficits in 29% (58). The most common tumors were low grade oligodendroglioma (58; 29%%) followed by glioblastoma (42; 21%). Mean length of hospital stay was 3.15 days ± 1.7 days. Gross total resection was achieved in 82 (41%) patients. New intraoperative neurological complains were seen in 31 (15.5%) patients, however, 22 (11%) of these had recovered by median follow-up of 1.4 months. KPS at last follow-up improved in 92 (46%), remained stable in 94 (47%) and deteriorated in 14 (7%) patients. Although absence of a control group decreases the strength of this, with our large sample size we can safely conclude that AC allows maximum safe excision of brain tumors, and offers a good chance of preserving patients’ functional status, along with adequate extent of resection.

INTRODUCTION In Pakistan, brain tumor epidemiology has been examined in single-centre studies or as part of general cancer registries, which are limited by catchment area, age group, or are not specific to brain tumors. The Pakistan Society of Neuro-Oncology conducted a nationwide study to assess the distribution of brain tumor distribution and associated risk factors. This unfunded study explores data from across Pakistan and serves as a potential model for LMICs to emulate. METHODS A cross-sectional study was designed to include patients diagnosed with brain tumors in major neurosurgical centers in Pakistan retrospectively from January-December 2019. Patients, both alive and deceased, with a radiological diagnosis of a brain tumor were included. Data were recorded on a comprehensive online form from 35 centers, encompassing an estimated 85% of all the brain tumor patients seeking initial treatment by a neurosurgeon from the public and private sectors. Data collection was split into three regions: Sindh and Balochistan; Punjab; and Khyber Pakhtunkhwa and Islamabad. Data collection occurred between August 2020 and January 2021. RESULTS A total of 2750 brain tumor cases were recorded of which 1897 (69%) were diagnosed in the private sector hospitals. MRIs were a more common radiological study compared to CT scans. 2666 surgeries were performed, 174 individuals underwent chemotherapy and 479 underwent radiation therapy; approximately two-thirds of the patients that require adjuvant treatment are not able to receive it. Gliomas were the most common tumor, while pineal tumors were the least common. Findings indicate a low metastasis frequency and few females seeking care. CONCLUSION The study shows that brain tumors are mostly diagnosed and operated on in the private sector; the public sector should be more engaged. The study also highlights that despite inconsistencies in hospital records for brain tumor patients, reliable information can be collected in LMIC settings.

Very little research has been conducted on brain tumor epidemiology in Pakistan and a few studies that do exist provide regional data only. Conducting population based epidemiological studies in low-and-middle income countries (LMICs) like Pakistan can be particularly challenging due to limited resources, poor clinical and research infrastructure, unreliable or incomplete hospital records and a lack of standardization across the health care system. Population-wide studies and registries play an important role in cancer epidemiology and can help identify the current magnitude of cancer burden and its likely future evolution, allowing for better planning of prevention, diagnosis, management, and rehabilitation. This paper describes our experience in designing and conducting Pakistan Brain Tumor Epidemiology Study (PBTES), a first-ever nationwide study carried out to assess the distribution of brain tumors in Pakistan. In addition to the aforementioned obstacles, we were also faced with the global health crisis caused by the COVID-19 pandemic and had to promptly adjust our study accordingly. Other investigators conducting epidemiological studies in LMICs with similarly challenging and constricting settings could benefit from our experiences.

To date, information on the management of specific neurosurgical tumors, such as glioma, in Pakistan remains scattered and scarce. Our review synthesizes the predicaments of glioma management routinely presented to the neurosurgery, medical oncology, radiation oncology, and radiology departments in Pakistan. Expert opinions were integrated from each of the relevant fields in the form of personal citations. The data presented in our review were collected from various PubMed and non-PubMed indexed articles, coupled with various health reports from the Government of Pakistan along with the World Health Organization. Through these data, it was postulated that the utilization of innovative and instrumental technologies is a constant struggle for neurosurgeons in Pakistan, considering the cost-effectiveness. Hence, this results in significant limitations for surgeons to provide the best outcome for their patients. As most Pakistanis (74%) pay out of pocket, measuring cost-effectiveness is extremely crucial. It was found that significant differences in intra-operative and postoperative care existed among various centers. Public sector institutions fared much worse. The role of diagnostics in glioma surgery is severely limited across centers in Pakistan and as such, research and training need to be addressed promptly. In order to achieve success in glioma management, the data in our article demonstrate various facets of health care that need to be addressed simultaneously and swiftly. Surgical access needs to be improved; only then, optimal management of glioma can be accomplished in Pakistan.

Objective: The aim of the current study was to observe functional outcomes of patients undergoing decompressive craniectomy (DC) for raised intracranial pressure (ICP) after blunt head injury and to assess possible predictive factors. Methodology: This study was a prospective cohort study which was conducted at Aga Khan University Hospital, Karachi over a period of 2 years (January 2015–December 2016). Adult patients, aged between 15 and 65 years of both genders undergoing DC during the study period were selected. Outcomes of DC were assessed at an interval of 3 months following injury using the Glasgow outcome score. The data were analyzed on IBM statistics SPSS version 21. Results: Seventy-two patients underwent DC for raised and refractory ICP. Glasgow Outcome Scale (GOS) at discharge, 1-month and 3-month follow-up were reported. GOS at 3-month follow-up showed 21 patients (29.2%) patients had a good recovery, moderate disability was reported in 16 patients (22.2%), and severe disability in 12 patients (16.7%), persistent vegetative state was seen in five patients (6.9%). Eighteen patients had in hospital mortality (25.0%). Tracheostomy and sphenoid fractures were found to be negative predictors of good functional outcome. Conclusions: DC is associated with an in hospital mortality of 25.0%. Favorable outcomes were seen in 51.4% patients. Tracheostomy and sphenoid fractures were negative predictors of good functional outcome. The results are comparable to international literature.

INTRODUCTION Gliomas are the most common malignant brain tumors of the central nervous system in adults. Specialized treatment modalities have improved morbidity and mortality within high-income countries. In lower- and middle-income countries (LMICs), the overall mortality rate is still seen to be alarmingly high. As there is a shortage of statistical data available regarding the epidemiology of these tumors and their management within the country, the objective of this study is to define the landscape of treatment patterns and current epidemiological data regarding gliomas in Pakistan. METHODS As part of the Pakistan Brain Tumor Epidemiology Study (PBTES), data was collected from major neurosurgical centers across the country, consisting of 35 hospitals in all 4 provinces. Our retrospective study looked at patients who underwent surgical procedures for gliomas in 2019, where a surgical pathology was available. The data was collated and analyzed using appropriate statistical methods. RESULTS 791 patients with gliomas were identified (61.8 % in public sector hospitals, 39.1% in private sector). The most common histopathological subtypes were glioblastoma (33.5%), followed by astrocytoma (18.8%) and oligodendroglioma (11.9%). Gender distribution was skewed towards men (65%). The most commonly performed initial surgical procedure was gross total resection (50% in public hospitals, 41% in private hospitals). Private institution hospitals performed surgical biopsies as the first surgical procedure (23%) more often than public hospitals (9%). Regarding adjuvant treatments, only 26% of patients were given chemotherapy, and there was no data regarding 53% of patients. Similarly, only 15% of patients received radiation therapy, and there was no data for 60% of patients. CONCLUSIONS Our study was able to identify the gaps in glioma management within Pakistan, particularly with regards to chemoradiotherapy. Identifying these unmet needs is the first step in developing comprehensive care for glioma patients.

INTRODUCTION Global oncology development within LMICs (low- and middle-income countries) requires bridging gaps in healthcare systems. Brain tumor care in Pakistan is currently sparse and concentrated in urban centers. Distance traveled to a hospital dictates a patient’s access to care, neurosurgical access, and continuity of care through adjuvant chemoradiotherapy and primary care providers can be disrupted if patients cannot overcome the barriers due to extensive distances traveled. METHODS Data was collected as part of the Pakistan Brain Tumor Epidemiology Study (PBTES) regarding patients with brain tumors who underwent surgical procedures in 2019 at private and public major neurosurgical centers across Pakistan. Using patient addresses, we used a mapping software to calculate the distance traveled by each patient to the primary hospital. Analysis was done using appropriate statistical methods. RESULTS Out of 2403 patients, the mean distance traveled across the country was 240 km. The longest distance traveled within Pakistan was from Skardu to Karachi (2002 km) for resection of a pituitary adenoma (28 hours via car). Only 48% of patients were able to reach their primary hospital within 50 km. 52% of patients had to travel more than 50 km, and 18% had to travel upwards of 500 km to reach their primary hospital. Additionally, 101 patients traveled to Pakistan from other countries for brain tumor surgery (98 patients from Afghanistan [mean distance traveled: 723.6 km], 3 patients from Syria, Oman, and Sudan). CONCLUSION Prior studies have described a cut-off of 50 km as an acceptable limit for distance from the primary hospital in cancer patients for optimal follow-up and outcomes, which is achieved by only 48% of brain tumor patients in Pakistan. Most patients have poor access to surgical care for brain tumors, further compounded by repeat traveling for follow-ups and chemoradiotherapy.

Paediatric brainstem gliomas (BSGs) can be classified broadly into two distinct categories: focal brainstem gliomas (FBSGs) and diffuse intrinsic pontine gliomas (DIPG). The former account for 20% of paediatric BSGs and are mostly indolent lesions with good prognosis. DIPGs constitute the remaining 80%, and are highly aggressive, malignant tumours having a dismal prognosis; being the foremost cause of death in children with brain tumours. Their poor response to treatment regimens is further complicated by their localization in eloquent brainstem areas, thereby making it difficult to establish a standardized framework of therapeutic intervention. In this review, the authors catalogue and appraise current treatment modalities utilized in the management of paediatric BSGs including steroid use, chemotherapy, radiotherapy, and surgery.

Pituitary adenomas and Rathke’s cleft cyst with calcification are rarely seen and craniopharyngioma still remains the common sellar suprasellar space occupying lesion with calcification. Presence of calcification is reported in pituitary adenoma in only 0.2% to 8% cases. The pituitary adenoma with calcification is a rare radiological finding and it must be distinguished from other lesions of the pituitary gland as the management and prognosis differs significantly. We report a case of a 29-year-old gentleman presented electively with the complaints of deterioration of vision for four months. CT-scan without contrast examination revealed pituitary adenoma with calcification. The patient underwent transsphenoidal resection and was discharged on third post-operative day. Histopathology confirmed the diagnosis of pituitary adenoma with calcification. Pituitary tumor presenting with evidence of calcification is an infrequent radiological finding and identification of pituitary adenomas with calcifications is essential as it guides towards medical and surgical management of the lesion.

Ever since the 1960s, transsphenoidal surgery has been the modality of choice for treating Cushing's disease. Subsequent visualization of the pituitary fossa and sphenoid sinus may be done either with the operating microscope or with the relatively new endoscope. The endoscope due to its panoramic view allows greater visualization as compared to the operating microscope. It confers greater access to the cavernous sinus, sella, suprasellar, and parasellar regions and accommodates higher magnifications. It is bi-dimensional, however as opposed to the operating microscope that provides a three-dimensional view and allows greater depth perception. This article provides a comprehensive review of the advantages and disadvantages of the endoscope and compares it to the operating microscope. We hope this article will prove useful to both clinicians and academicians alike in their approach and management of Cushing's disease.

Background and purposeThis study aimed to determine the accuracy of apparent diffusion coefficient (ADC) and enhancement ratio (ER) in discriminating primary cerebral lymphomas (PCL) and glioblastomas.Materials and methodsCircular regions of interest were randomly placed centrally within the largest solid-enhancing area of all lymphomas and glioblastomas on both post-contrast T1-weighted images and corresponding ADC maps. Regions of interest were also drawn in the contralateral hemisphere to obtain enhancement and ADC values of normal-appearing white matter. This helped us to calculate the ER and ADC ratio.ResultsMean enhancement and ADC (mm2/s) values for PCL were 2220.56 ± 2948.30 and 712.00 ± 137.87, respectively. Mean enhancement and ADC values for glioblastoma were 1537.07 ± 1668.33 and 1037.93 ± 280.52, respectively. Differences in ADC values, ratios and ERs were all statistically significant between the two groups ( p ConclusionsADC values, ADC ratios and ERs may serve as useful variables to distinguish PCL from glioblastoma. The combination of ADC ratio and ER yielded the best results in identification of both patient subgroups.

Spinal metastases constitute two-third of all cases of bone metastases. Surgical intervention in these tumours has been recommended in highly selective cases, for confirming diagnosis, stabilizing the spine, and decompressing nerves or spinal cord for alleviation of pain and preservation of function.In this article,the authors have reviewed available evidence on role of surgery in spinal metastases and have presented results of selected papers on this vast topic.

Seizures are common in patients with brain tumours, even though prophylactic anti-seizure treatment for all patients with brain tumours is not recommended. Newer anti-epileptic drugs have shown benefits that outweigh the side effects of treatment and can also be given in combination with traditional anti-epileptic drugs. The authors have reviewed the literature on the various combinations of anti-epileptics in patients with seizures and brain tumours.

Oligodendrogliomas are common intra-axial primary brain tumours, and carry special significance due to several key features, which when present provide better prognosis compared to other intra-axial tumours. One of these features is presence of 1p/19q chromosomal codeletion that seems to not only be a marker of better prognosis but also signifies better response to chemotherapy. Herein the authors review the literature for evidence of the prognostic value of 1p/19q codeletion in OD.

Glioblastoma, also known as glioblastoma multiforme (GBM), is the most common primary brain tumor. Extensive research has been carried out to discover the factors associated with the course and progression of GBM. CD133 is a glycoprotein antigen found in normal and malignant tissues. CD133 has been recognized as a marker for the growth of cancer cells. The association between this tissue marker and GBM is being investigated. The aim of this review was to evaluate the role of CD133 as a tumor marker for the prognosis of GBM.

Third ventricle tumors are uncommon and account for 0.6 - 0.9% of all the brain tumors. Tumors of the third ventricle are classified into primary tumors, such as colloid cysts, choroid plexus papillomas, and ependymomas, or secondary tumors, such as craniopharyngiomas, optic nerve gliomas, pineal tumors, and meningiomas. Third ventricular tumors are uncommon, and their treatment involves significant morbidity and mortality. The colloid cyst has a better surgical outcome and many approaches are available to achieve a complete cure. Choroid plexus papilloma is also a common tumor documented with its treatment majorly based on surgical resection. In addition to multiple treatment options for craniopharyngiomas, surgery is the most preferred treatment option. Ependymomas also have few treatment options, with surgical resection adopted as the first line of treatment.