Tectal Gliomas: Natural History of an Indolent Lesion in Pediatric Patients

Abstract

The mesencephalic tectal glioma is a distinctive form of brain stem glioma with an unusually benign clinical course. Periaqueductal location, lack of contrast enhancement, and long periods of stability are classic features. The clinical management of these lesions, especially at the time of radiographic enlargement varies widely in the published literature. It is unclear whether these progressive lesions need to be treated. Accordingly, clinical and radiologic features of 7 patients were reviewed, with attention to the clinical course of the disease after radiologic enlargement. The age at diagnosis ranged from 3.3 to 16.6 years. Six of 7 had MRI tumor enlargement beginning 0.3–5.7 years after initial diagnosis. One of these 6 patients had radiographic progression coupled with a new clinical symptom which was treated with stereotactic radiation therapy. The remaining 5 patients with MRI progression and normal neurological exams were not treated and remain free of new neurologic deficits 1.8–6.9 years after the first radiographic tumor enlargement. The results suggest that pediatric tectal gliomas are a very low-grade lesion. Conservative management in the absence of new clinical symptoms could be argued, reserving radiotherapy or chemotherapy for clinical progression.

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

“…Patients treated conservatively had tumor volume comparable to our study patients, which is also more in line with tumor volumes reported by others. 1,3,22 The significance of radiological progression is controversial, as progression without concurrent development of clinical symptoms has been observed in a large number of patients with tectal plate gliomas. 1 In regard to imaging characteristics, our study confirms the findings of others that tectal plate gliomas are frequently isointense on T1-weighted images, hyperintense on T2-weighted images, and have a low rate of contrast enhancement.…”

“…1,3,22 The significance of radiological progression is controversial, as progression without concurrent development of clinical symptoms has been observed in a large number of patients with tectal plate gliomas. 1 In regard to imaging characteristics, our study confirms the findings of others that tectal plate gliomas are frequently isointense on T1-weighted images, hyperintense on T2-weighted images, and have a low rate of contrast enhancement. 3,4,21 None of these imaging features was predictive of tumor enlargement in our study.…”

Favorable outcome with conservative treatment for children with low grade brainstem tumors

“…Tectal lesions may be indolent. Therefore, first line treatment consists of CSF diversion with no biopsy or further tumor-specific treatment in most cases [9][10][11]. Dorsally exophytic and focal pontomedullary lesions may be pathologically low grade and are frequently associated with long-term survival [12][13][14][15].…”

Total Resection of a Hemorrhagic Tectal Pilocytic Astrocytoma-Case Report-

“…3,16) However, some cases with atypical neuroimaging and/or clinical progression and some exceptionally aggressive cases required further treatment, such as surgical resection or radiotherapy. 2,5,[7][8][9][14][15][16][18][19][20] In the present case, we decided to perform radical resection of the enhanced tumor because of the unusual aggressive clinical course with hemorrhage and the possibility of malignant components. The surgical cure was successful without neurological deficits.…”

“…The overwhelming majority of tectal tumors are low-grade astrocytomas. [1][2][3]10,12,14,16) Accordingly, tectal tumors are often described as a distinctive subset of brain stem glioma with an unusually benign clinical course, and the diagnosis of`benign tectal glioma' is often based on the neuroimaging appearance and indolent clinical course of the lesion. 2,3,13,14) Here we describe a case of tectal pilocytic astrocytoma with the extremely unusual initial manifestation of intracranial hemorrhage.…”