Intrinsic tectal low grade astrocytomas: is surgical removal an alternative treatment? Long-term outcome of eight cases

Abstract

Low-grade gliomas arising in dorsal midbrain in children and young patients usually present few neurological symptoms and findings, and patients management is controversial. Some authors propose only clinical observation until the patient present signs of increased intracranial pressure when a shunt with or without biopsy, is inserted; others recommend radiotherapy after stereotactic or open biopsy. Microsurgical total removal of tumor may be curative. We present a retrospective analysis of eight patients (mean age 16.6 +/- 11.5 years-old) with low-grade astrocytoma of the tectal region operated on using an infratentorial/supracerebellar approach between 1981 and 2002. All patients presented hydrocephalus and had a shunt insertion before surgical resection of the lesion. The tumour could be totally resected in seven patients. In one case radical removal was not possible due to infiltrative pattern of the lesion. Postoperative radiotherapy was performed in two cases, one patient at the beginning of this series and in the case with infiltrative tumor. This patient presented progressive tumor growth and died five years after surgery. No recurrence occurred after total removal. Post-surgical follow-up time ranged from 2 1/2 to 22 1/2 years (mean 9.9 +/- 5.9 years). Radical microsurgical removal of non invasive tumors is possible without mortality or significant morbidity. It may be curative and should remain as an alternative to be discussed with the patient.

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

“…21 Tectal plate gliomas typically behave in a benign and indolent fashion, and only a small number will exhibit progression, result in new neurological symptoms, and require treatment including surgery, radiation therapy, and chemotherapy. 2,5,[13][14][15][20][21][22] The challenge in the management of tectal plate gliomas remains in the uncertainty of knowing which tumors will eventually exhibit clinically significant growth. In our study, 44 patients diagnosed with tectal plate glioma on MRI underwent follow-up clinically and radiologically for a mean of 7.6 years and 6.5 years, respectively.…”

Pediatric tectal plate gliomas: a review of clinical outcomes, endocrinopathies, and neuropsychological sequelae

“…Neurosurgical interventions have been described, but few references in the literature describe long-term outcome [3][4][5][6][7][8]. Those references that do discuss outcomes are small case series, suggesting that this lesion has an indolent, non-aggressive course [9,10].…”

6‐year‐old Girl With Hydrocephalus

“…Mesencephalic tectal glioma is a topographical diagnosis consisting of a heterogeneous group of gliomas in children, with relatively benign and indolent clinical course in most previous case reports (1–3, 5, 9–11). Although the histopathological features of this tumor are compatible with a diagnosis of mixed oligoastrocytoma, the FISH study showed that this tumor is negative for co‐deletion of chromosomes 1p and 19q.…”

“…As noted by most previous authors, appropriate management of pediatric tectal gliomas depends on the clinical symptoms as well as the histopathology of these tumors. Due to the relatively indolent clinical course of most pediatric tectal tumors, most authors advocate conservative treatments to manage hydrocephalus (1–3, 5, 7–11). However, rare high grade astrocytoma with aggressive clinical behavior also have been reported (6, 12).…”