Management of intrinsic gliomas of the tectal plate in children - A ten-year review

The natural history, management, and long-term outcome for patients with be nign, intrinsic tectal plate gliomas remain controversial in spite of their propensity to cause late-onset hydrocephalus. A 10-year retrospective revi ew has identified 11 consecutive children with tectal plate lesions. Headac he, vomiting, a decline in school performance, tremor, and complex partial seizures were common presenting symptoms. All patients presented with signs and symptoms of hydrocephalus. Magnetic resonance (MR) imaging delineated an intra-axial mass lesion of the midbrain primarily localized to the tecta l plate which uniformly was hyperintense on T2-weighted imaging and had a m ore variable appearance on T1-weighted imaging and rare enhancement with ga dolinium. No patient underwent surgical resection, chemotherapy, or radioth erapy. Three of 11 patients (27%) showed evidence of progression in size or a new focus of enhancement on MR imaging, which was clinically asymptomati c. In this series, no patient with a tectal plate lesion less than 1.5 cm i n maximal diameter and without gadolinium enhancement showed any evidence o f clinical or radiological progression. Although intrinsic tectal lesions i n children are clinically indolent and the initial management consists of C SF diversion, these lesions may eventually progress and still warrant long- term follow-up with serial MR imaging. Copyright (C) 2000 S. Karger AG, Bas el.