Neuroendoscopic approach to tectal tumors: a consecutive series

Object. The authors report a consecutive series of 10 patients who presente d with signs and symptoms caused by tectal rumors. Clinical findings, radio graphic features, neuroendoscopic management strategies, and histological f indings are reported and discussed. Methods. Since January 1990, 11 neuroendoscopic procedures were performed i n 10 patients who harbored tectal tumors. The patients were followed for an average of 5 years (range 2 months-11 years), and a retrospective study wa s conducted in which case notes. radiological findings, operative notes, an d histopathological findings were assessed. Magnetic resonance (MR) imaging was performed and the images were used to classify patients into three gro ups: those with hypertrophy of the tectum in whom isointensity appeared on T-1-weighted images (Group 1), those with a tec tai tumor occupying the cer ebral aqueduct in whom decreased signal intensity appeared on T-1-weighted images, as well as no enhancement after gadolinium administration (Group 2) . and those with a tectal tumor in whom mixed signal intensity and conspicu ous evidence of contrast enhancement appeared on T-1-weighted images (Group 3). The results of histological examination were consistent with MR imagin g features: in Group 1, glial tissue or gliosis; in Group 2, benign astrocy toma; and in Group 3, malignant astrocytoma. Cerebrospinal fluid diversion was the only surgical treatment that provided relief from obstructive hydro cephalus. One patient in Group 3 underwent radiotherapy and subsequent part ial tumor removal under neuroendoscopic guidance. Thereafter, the tumor rem ained in decline. All patients had normal intellectual status after undergo ing surgery in which a neuroendoscope was used. Conclusions. Neuroendoscopic procedures can provide histological diagnosis, define the tumor-midbrain interrelationship, and be highly effective in tr eating obstructive hydrocephalus and in removing tectal tumors. This proced ure may receive clinical application as a new management strategy for recta l glioma.