Tectal plate lesions in children
Jessica Ternier1, Alison Wray, Stéphanie Puget
1Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Paris, France.
Insights
Pediatric tectal plate lesions require contrast-enhanced MRI and volume assessment. Lesion volume predicts progression, with smaller lesions (<4 cm3) often benign hamartomas and larger lesions (>10 cm3) typically tumors requiring treatment.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Pediatric Neurosurgery
Background:
- Tectal plate lesions in children can present with hydrocephalus.
- Differentiating benign hamartomas from tumors is clinically important.
Purpose of the Study:
- To characterize the clinical course of pediatric tectal plate lesions.
- To identify prognostic factors predicting lesion progression.
- To differentiate tectal hamartomas from tumors.
Main Methods:
- Retrospective review of pediatric tectal plate lesions (1984-2003).
- Analysis of lesion volume, clinical, and radiological features on magnetic resonance (MR) imaging.
- Correlation of presentation factors with clinical course and outcomes.
Main Results:
- Lesion volume at presentation was the only factor predicting tumor enlargement (p = 0.002).
- Subgroups based on volume (<4, 4-10, >10 cm3) correlated with clinical course.
- 39 of 40 patients remained stable; one died from high-grade astrocytoma.
Conclusions:
- Contrast-enhanced MR imaging and volume assessment are crucial for pediatric tectal lesions.
- Lesions <4 cm3 are likely hamartomas with benign courses.
- Lesions >10 cm3 are typically tumors requiring treatment; earlier intervention may improve outcomes.
Object:
The authors characterized the clinical course of tectal plate lesions in a group of pediatric patients to identify the prognostic factors at presentation that predict progression, in an attempt to differentiate tectal hamartomas from tumors.
Methods:
A retrospective review was conducted of the management of tectal plate lesions in children since the advent of magnetic resonance (MR) imaging at the authors' hospital (1984-2003). The lesion volume seen on MR images, the clinical and radiological features at presentation, and the clinical course of the population were analyzed for correlations. Forty children with tectal lesions presented in the typical delayed fashion (mean 8.5 months) with symptoms referable to hydrocephalus (93%). Fourteen children whose tumors demonstrated radiological progression (enlargement, contrast enhancement, or cystic change) were treated surgically. Histologically, 80% of the surgically treated lesions were low grade (with the other 20% consisting of one dysplasia, one high-grade tumor, and one unidentified tumor). Five patients required a second operation and one required a third. One patient died of a high-grade astrocytoma after undergoing surgery and radiotherapy; the other 39 patients remain clinically stable. The only factor predictive of tumor enlargement was lesion volume at presentation (p = 0.002). Distribution analysis revealed three subgroups based on lesion volume (< 4, 4-10, and > 10 cm3), which correlated with the clinical course of the disease.
Conclusions:
Children with tectal lesions should undergo contrast-enhanced MR imaging and volume assessment at the time of presentation. After hydrocephalus has been managed with endoscopic third ventriculostomy, these children require prolonged, close clinical and radiological surveillance. Lesions with a volume less than 4 cm3 were likely to be hamartomas and followed a predominantly benign course, with few atypical cases progressing. All large lesions, defined as having a volume greater than 10 cm3 at presentation, eventually required treatment, and all were histologically determined to be tumors. An argument is made for earlier treatment of larger lesions with the aim of improving outcome.
