Tectal Plate Glioma Presenting With Intratumoral Hemorrhage

Tectal gliomas are rare brainstem tumors. These tumors typically cause obstructive hydrocephalus due to mass effect on the cerebral aqueduct; however, intratumoral hemorrhage is exceedingly rare, with only one previously documented case to our knowledge. Patients typically present with symptoms of hydrocephalus, including headaches, nausea, and visual disturbances. We report the case of a 43-year-old man with a known tectal plate glioma who presented with acute obstructive hydrocephalus secondary to intratumoral hemorrhage. Following the patient's rapid neurological decline, computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the diagnosis. The patient underwent an endoscopic third ventriculocisternostomy (ETV) for cerebrospinal fluid diversion, along with an endoscopic biopsy of the tectal mass. The patient's postoperative course was favorable, with gradual resolution of symptoms, including diplopia and headaches. A follow-up MRI revealed reduced tumor size and stable ventriculomegaly. Histopathological analysis suggested the tumor to be of glial origin and low-grade in nature, based on its contrast enhancement on MRI and the patient's clinical trajectory. This case illustrates a rare presentation of intratumoral hemorrhage in tectal gliomas, emphasizing the need for heightened clinical suspicion in such cases. ETV remains an effective treatment for obstructive hydrocephalus, though the potential for hemorrhagic complications warrants close monitoring.