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Tectal Plate Gliomas Masquerading as Idiopathic Aqueduct Stenosis
Fardad T Afshari1, Martin English2, William B Lo1
1Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, United Kingdom.
Insights
Endoscopic third ventriculostomy effectively treats obstructive hydrocephalus. However, concealed tectal gliomas can initially mimic aqueduct stenosis, requiring postoperative imaging to reveal the true cause.
Area of Science:
- Pediatric Neurosurgery
- Neuro-oncology
- Neuroradiology
Background:
- Aqueduct stenosis is a common cause of obstructive hydrocephalus in children.
- Endoscopic third ventriculostomy (ETV) is a standard treatment for aqueduct stenosis.
- Preoperative imaging often diagnoses the cause of stenosis.
Purpose of the Study:
- To report a previously unrecognized phenomenon of concealed tectal gliomas presenting as idiopathic aqueduct stenosis.
- To emphasize the importance of postoperative imaging after ETV for hydrocephalus.
Main Methods:
- Case report of two pediatric patients with obstructive hydrocephalus.
- Diagnosis initially presumed to be idiopathic aqueduct stenosis.
- Successful ETV followed by repeat MRI revealing tectal plate gliomas.
Main Results:
- Post-ETV imaging unmasked tectal plate gliomas as the cause of obstruction in both cases.
- Hydrocephalus decompression revealed the underlying glioma.
- This highlights a potential pitfall in diagnosing aqueduct stenosis.
Conclusions:
- Concealed tectal gliomas can masquerade as idiopathic aqueduct stenosis.
- Routine postoperative imaging after ETV is recommended to identify missed underlying pathologies.
- Awareness of this phenomenon can prevent misdiagnosis and ensure appropriate treatment.
Abstract:
Aqueduct stenosis is a recognized cause of obstructive hydrocephalus in children and can be treated effectively with endoscopic third ventriculostomy. Preoperative magnetic resonance imaging is often diagnostic of the cause of aqueduct stenosis. We describe 2 pediatric cases with obstructive hydrocephalus secondary to a working diagnosis of idiopathic aqueduct stenosis. Following successful endoscopic third ventriculostomy, repeat magnetic resonance brain imaging revealed tectal plate glioma as the primary cause of obstruction. We believe these 2 reported cases demonstrate a previously unreported phenomenon whereby concealed tectal gliomas presenting with hydrocephalus are only unmasked following relief of hydrocephalus and decompression and normalization of the ventricular system. We aim to raise awareness about this unusual phenomenon and recommend routine postoperative interval imaging following endoscopic third ventriculostomy to avoid missing underlying pathology masquerading as aqueduct stenosis.
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