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Management of tectal glioma in childhood
Andreas M Stark1, Michael J Fritsch, Alexander Claviez
1Department of Neurosurgery, University of Schleswig-Holstein Medical Center, Campus Kiel, Schittenhelmstrasse 10, 24105 Kiel, Germany.
Insights
Tectal gliomas, rare brainstem tumors in children, often present with increased intracranial pressure. Management focuses on hydrocephalus treatment, with these tumors generally having a favorable prognosis.
Area of Science:
- Pediatric neuro-oncology
- Neurosurgery
- Pediatric neurology
Background:
- Tectal glioma is a topographical diagnosis encompassing various histologies, predominantly low-grade astrocytomas.
- Clinical presentation commonly involves symptoms of increased intracranial pressure, though other neurological signs can occur.
Purpose of the Study:
- To review the management and outcomes of pediatric tectal glioma.
- To highlight the importance of addressing hydrocephalus in these patients.
Main Methods:
- Retrospective review of 12 pediatric patients diagnosed with tectal glioma between 1976 and 2001.
- Analysis of clinical presentation, treatment strategies, and follow-up data.
Main Results:
- The mean age at diagnosis was 6.75 years, with symptom-to-diagnosis duration varying widely.
- Endoscopic third ventriculostomy and ventriculoperitoneal shunting were primary treatments for hydrocephalus.
- Histological confirmation in 5 cases revealed predominantly low-grade astrocytomas.
- All patients maintained good neurological function post-treatment.
Conclusions:
- Tectal glioma is a distinct subgroup of brainstem tumors with a favorable prognosis.
- Effective management of hydrocephalus is crucial for favorable outcomes.
- Regular clinical and imaging surveillance is recommended, with biopsy considered for progressive cases.
Abstract:
Tectal glioma is a topographical diagnosis including tumors of different histology, mainly low-grade astrocytomas. Clinical symptoms are usually associated with increased intracranial pressure. This report discusses the management of this rare tumor in children. Clinical charts of 12 children with tectal glioma treated in our department between 1976 and 2001 were retrospectively reviewed. The mean age at the time of diagnosis was 6.75 years (range, 4 weeks to 16 years). The duration between first symptoms and the diagnosis of tectal glioma was in the range of 2 days to 9 years. Ten patients presented with symptoms associated with increased intracranial pressure, one patient presented with ataxia, and in one case tectal glioma was an incidental finding. First-line therapy was endoscopic third ventriculostomy in 5 cases (42%), ventriculoperitoneal shunting in 6 cases (50%), and combined partial tumor resection and shunting in one case. Histology was obtained in 5 cases (low-grade astrocytoma, n = 4; ependymoma, n = 1). All patients had good neurologic function at the end of follow-up. Tectal glioma represents a distinct subgroup of brainstem tumors associated with a good (or favorable) prognosis. Effective treatment for hydrocephalus is essential; the tumor should be monitored by regular clinical examination and magnetic resonance imaging. Biopsy is warranted in cases with tumor progression.
