Neuroendoscopic approach to tectal tumors: a consecutive series

Abstract

<jats:p>The authors report a consecutive series of 10 patients who presented with signs and symptoms caused by tectal tumors. Clinical findings, radiographic features, neuroendoscopic management strategies, and histological findings are reported and discussed.</jats:p> <jats:p>Since January 1990, 11 neuroendoscopic procedures were performed in 10 patients who harbored tectal tumors. The patients were followed for an average of 5 years (range 2 months to 12 years), and a retrospective study was conducted in which case notes, radiological findings, operative notes, and histopathological findings were assessed. Magnetic resonance (MR) imaging was performed, and the images were used to classify patients into three groups: those with hypertrophy of the tectum in whom isointensity appeared on T<jats:sub>1</jats:sub>-weighted images (Group 1); those with a tectal tumor occupying the cerebral aqueduct in whom decreased signal intensity appeared on T<jats:sub>1</jats:sub>-weighted images, as well as no enhancement after gadolinium administration (Group 2); and those with a tectal tumor in whom mixed signal intensity appeared on T<jats:sub>1</jats:sub>-weighted images and conspicuous evidence of contrast enhancement (Group 3). The results of histological examination were consistent with MR imaging features: in Group 1, glial tissue or gliosis; in Group 2, benign astrocytoma; and in Group 3, malignant astrocytoma. Cerebrospinal fluid diversion was the only surgical treatment that provided relief from obstructive hydrocephalus. One patient in Group 3 underwent radiotherapy and subsequent partial tumor removal under neuroendoscopic guidance. Thereafter, the tumor remained in decline. All patients had normal intellectual status after undergoing surgery in which a neuroendoscope was used.</jats:p> <jats:p>Neuroendoscopic procedures can provide histological diagnosis, define the tumor-midbrain interrelationship, and be highly effective in treating obstructive hydrocephalus and in removing tectal tumors. This procedure may receive clinical application as a new management strategy for tectal glioma.</jats:p>

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

“…In 1999, Oka et al [4] classified tectal tumors into 3 groups based on MRI appearance, neuroendoscopic findings, histopathology, and postoperative clinical findings: group 1 - gliosis, group 2 - benign astrocytomas, and group 3 - anaplastic astrocytomas [4]. Today, it is well known that most tectal lesions are either hamartomas or pilocytic astrocytomas.…”

“…Several reports have demonstrated that only 20-30% of all lesions show interval growth on follow-up MRIs, requiring surgical resection at some point [2,3,4]. Thus, the management of most patients is conservative, treating the commonly present hydrocephalus with a ventriculoperitoneal shunt (VPS) or endoscopic third ventriculostomy (ETV), with long-term clinical follow-up using serial MRIs for changes in tumor signal or size [5,7,8].…”

“…A review of the literature indicated that 80% of the tumors are low-grade gliomas [2,3,4] that typically appear on MRIs as hypo- or isointense masses on T1, hyperintense on T2, and rarely enhance after contrast injection [5,6]. …”

Endoscopic‐Assisted Intracranial Tumor Removal in Dogs and Cats: Long‐Term Outcome of 39 Cases

“…Most of these reports describe the use of endoscopes in minimally invasive approaches to the supraorbital region 11 or removal of tumors in difficult to access areas such as the pineal, 12 tectal, 13 sellar, 7 posterior fossa, [14][15][16] and intraventricular regions. [17][18][19] Studies in people have primarily focused on technique, safety, and efficacy of endoscopic assistance [20][21][22] ; there are no reports directly comparing outcomes between endoscopic-assisted procedures to similar procedures without use of the endoscope.…”

Biopsia neuroendoscópica: Revisión de la literatura y experiencia en 31 pacientes

“…Se ha descrito como una de las principales limitaciones de la neuroendoscopia el inadecuado control de las hemorragias cuantiosas 6 . Se postula que técnicas como la coagulación con láser podrían ayudar a solventar esta complicación 12,17 . Aún no se ha conseguido determinar si la diseminación leptomeníngea de algunas neoplasias puede estar favorecida por la técnica endoscópica o si es parte de la evolución natural de la enfermedad 2,16 .…”