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

Abstract

Background/Aims: Different tectal masses have been described; most are low-grade gliomas. Only 20-30% of all lesions grow, as shown on follow-up MRIs, requiring surgical resection at some point. The aim of this study is to describe the experience of a single institution managing pediatric patients with tectal lesions. Methods: We retrospectively studied and analyzed 40 children with tectal lesions managed from 1990 to 2006; the mean age at diagnosis was 9.4 years. A volumetric classification was used to analyze tumor growth trends. More than 1 year of imaging follow-up was available for 23 patients. Results and Conclusion: Medium- and large-volume-size lesions were associated with the need for surgery. About half of the nonsurgical lesions grew at least 50% over a period of 4.5 years and did not require surgical resection.

Tectal glioma as a distinct diagnostic entity: a comprehensive clinical, imaging, histologic and molecular analysis

“…Adjuvant therapy with chemotherapy and/or focal radiation is often employed in patients with PD [ 4 , 5 , 14 , 17 , 21 , 25 , 30 , 32 , 34 , 38 , 41 – 43 , 45 ]. In our study, significant predictors of progression included tumor size greater than 3cm 2 , contrast enhancement and cystic changes at diagnosis, confirming the suggestions of previous reports [ 22 , 34 , 43 ]. To evaluate the role of adjuvant therapy and treatment outcome, we extensive reviewed clinical reports on pediatric TG (< 21 years at diagnosis, 5 or more patients) and combined with data from our cohort (Additional file 7 : Table S6) [ 1 , 4 , 5 , 7 – 9 , 14 – 17 , 20 – 22 , 25 , 26 , 28 , 30 , 32 – 34 , 37 – 39 , 41 – 43 , 45 , 48 ].…”

“…Misdiagnosis of TG as aqueductal stenosis based on CT, as in three of our patients, was common and was associated with even longer symptom durations before TG diagnosis [ 5 ]. The more widespread application of MRI for neuroimaging has resulted in incidental diagnoses of TG [ 1 , 14 , 17 , 22 , 26 , 32 – 34 , 41 , 42 , 48 ]. TG was an incidental finding in up to 27% of patients in various series and in an even higher percentage when MRI was part of a structured surveillance, as in children with NF1 [ 14 , 33 ].…”

“…However, this accomplishment was at the expense of a vegetative state and death in one patient and surgical complications requiring early re-operation in four others, as well as other complications including visual-field defects, Parinaud syndrome, and mutism in further patients. Other studies reserved tumor biopsy/resection for disease progression [ 22 , 43 ]. Similar to our cohort, around one-third of patients in the literature eventually required tumor-directed surgery, and visual deficits, gaze palsies, and intracranial hemorrhages remained significant complications.…”

“…Given the usual indolent course and risk associated with resection in such an eloquent area, the general recommendation is close observation after CSF diversion for hydrocephalus. Many studies on patient outcome are based on neurosurgical series with possible bias [ 5 , 8 , 9 , 16 , 17 , 20 , 22 , 25 , 26 , 28 , 32 , 38 , 42 , 43 , 45 , 48 ]. Data on progression predictors, long-term morbidities, and molecular features of this peculiar group of LGG are lacking.…”

Hydrocephalus presenting as idiopathic aqueductal stenosis with subsequent development of obstructive tumor: report of 2 cases demonstrating the importance of serial imaging

“…20 Tectal plate tumors may also cause obstructive hydrocephalus. These neoplasms are often slow-growing lowgrade gliomas, 2,9 and gadolinium enhancement may not be apparent, particularly early in the course. Therefore, serial MRI follow-up of tectal gliomas with attention to the tectal plate on FLAIR and gadolinium-enhanced sequences is necessary as progression to higher-grade gliomas has been described in the literature.…”