Management strategies for pediatric patients with tectal gliomas: a systematic review

Abstract

Pediatric tectal gliomas generally have a benign clinical course with the majority of these observed radiologically. However, patients often need treatment for obstructive hydrocephalus and occasionally require cytotoxic therapy. Given the lack of level I data, there is a need to further characterize management strategies for these rare tumors. We have therefore performed the first systematic review comparing various management strategies. The literature was systematically searched from January 1, 2000, to July 30, 2020, to identify studies reporting treatment strategies for pediatric tectal gliomas. The systematic review included 355 patients from 14 studies. Abnormal ocular findings—including gaze palsies, papilledema, diplopia, and visual field changes—were a common presentation with between 13.6 and 88.9% of patients experiencing such findings. CSF diversion was the most performed procedure, occurring in 317 patients (89.3%). In individual studies, use of CSF diversion ranged from 73.1 to 100.0%. For management options, 232 patients were radiologically monitored (65.4%), 69 received resection (19.4%), 30 received radiotherapy (8.4%), and 19 received chemotherapy (5.4%). When examining frequencies within individual studies, chemotherapy ranged from 2.5 to 29.6% and radiotherapy ranged from 2.5 to 28.6%. Resection was the most variable treatment option between individual studies, ranging from 2.3 to 100.0%. Most tectal gliomas in the pediatric population can be observed through radiographic surveillance and CSF diversion. Other forms of management (i.e., chemotherapy and radiotherapy) are warranted for more aggressive tumors demonstrating radiological progression. Surgical resection should be reserved for large tumors and/or those that are refractory to other treatment modalities.

Glioma tectal pediátrico con hidrocefalia y ventriculomegalia. Dos casos clínicos

“…La derivación del líquido cefalorraquídeo fue el procedimiento realizado con más frecuencia (en el 89,3 % de los pacientes). 9 Cuando se diagnostica hidrocefalia, los pacientes reciben un tratamiento quirúrgico como la tercer ventriculostomía endoscópica o la derivación ventrículo-peritoneal. La derivación auriculo-ventricular también es una opción válida en casos específicos.…”

Unveiling the Efficacy of Gamma Knife Radiosurgery for Tectal Plate Gliomas

“…More aggressive management, including surgery, chemotherapy, or RT, may be necessary for rapidly growing or atypical tumors. 12 Surgery is rarely used but can be considered for larger or progressive tumors, often followed by adjuvant therapy. TPG surgery carries significant risks and potential complications; however, newer techniques like fully endoscopic approaches offer safer options.…”

Diffuse Midline Gliomas: Challenges and New Strategies in a Changing Clinical Landscape

“…The ability to separate such benign histology (e.g., pilocytic) as seen on imaging, regardless of location, from more malignant counterparts allowed for a different surgical approach, as gross total resection can often be curative for well-encapsulated pilocytic malignancies of both the supratentorial and infratentorial compartments [ 40 ]. MRI further allowed for the differentiation between (malignant) pontine DMGs from (benign) tectal lesions, which, albeit carry significant clinical risk in the setting of aqueductal obstruction, often have a benign histology that only warrants CSF diversion in the form of shunting or third ventriculostomy [ 41 , 42 , 43 ].…”