Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Tectal plate gliomas are generally low-grade astrocytomas with favorable prognosis, and observation of the lesion and management of hydrocephalus remain the mainstay of treatment.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A cohort of patients with tectal plate gliomas at 2 academic institutions was retrospectively reviewed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Forty-four patients with a mean age of 10.2 years who harbored tectal plate gliomas were included in the study. The mean clinical and radiological follow-up was 7.6 ± 3.3 years (median 7.9 years, range 1.5–14.7 years) and 6.5 ± 3.1 years (median 6.5 years, range 1.1–14.7 years), respectively. The most frequent intervention was CSF diversion (81.8% of patients) followed by biopsy (11.4%), radiotherapy (4.5%), chemotherapy (4.5%), and resection (2.3%). On MR imaging tectal plate gliomas most commonly showed T1-weighted isointensity (71.4%), T2-weighted hyperintensity (88.1%), and rarely enhanced (19%). The initial mean volume was 1.6 ± 2.2 cm<jats:sup>3</jats:sup> and it increased to 2.0 ± 4.4 cm<jats:sup>3</jats:sup> (p = 0.628) at the last follow-up. Frontal and occipital horn ratio (FOHR) and third ventricular width statistically decreased over time (p &lt; 0.001 and p &lt; 0.05, respectively).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The authors' results support existing evidence that tectal plate gliomas frequently follow a benign clinical and radiographic course and rarely require any intervention beyond management of associated hydrocephalus.</jats:p></jats:sec>

Tectal Lesions in Children: A Long-Term Follow-Up Volumetric Tumor Growth Analysis in Surgical and Nonsurgical Cases

“…This finding suggests that NF-1 tumors have a higher tendency to progress and grow faster compared to non-NF tumors. This asseveration is different than that reported by Griessenauer et al [9], who suggested that the non-NF patients in their series had larger tumor volumes than those with NF, who had more indolent courses. However, many recent publications have proposed that NF-1-associated brain tumors, including ‘unidentified bright objects', have higher rates of progression than previously thought, even to the point of requiring surgical intervention with progression rates ranging from 30 to 75% [14,15,16].…”

“…We found that at diagnosis, the mean and median lesion volume for all 31 patients was 4.74 and 1.59 cm 3 , respectively. Depending on the series with which we compared it, the volumes were either similar, such as in the study by Ternier et al [5], or larger, as found in the series by Griessenauer et al [9]. Also, as noticed in prior reports, the larger the tumor's size, the higher the chances of the need for resective surgery [5].…”

“…Our surgical patients had a median volume at diagnosis of 6.52 cm 3 and 8.05 cm 3 at surgery, which was statistically significant compared to tumors smaller than 4 cm 3 (p ≤ 0.001). Griessenauer et al [9] reported only 2.3% tumor resection in their series, which is attributed to the small initial lesion volume, which averaged 1.6 ± 2.2 cm 3 .…”

“…The data were scattered, and few large series of up to 44 patients have been published [5,9]. While reviewing other publications, we realized that the concept of interval tumor growth was neither determined nor described, and thus, attempting to compare growth patterns between published series was discouraging (when reading about a chance of 10-30% for lesion growth on follow-up MRIs, the degree of interval growth was unclear).…”

“…In recent publications, authors have addressed this concern by looking for tumor progression prognostic factors; however, very few publications have gathered a series of more than 40 patients [5,9]. Ternier et al [5], for example, published a retrospective study of 40 children with tectal lesions, whereby 14 had imaging tumor progression and underwent surgery.…”