Neuroendoscopic biopsy of tectal glioma: A case report

Objective and importance: A type of intrinsic dorsal midbrain glioma known as benign tectal glioma can cause obstructive hydrocephalus. Because of its slow progress and relatively good prognosis, initial treatment should be c erebrospinal fluid diversion and biopsy. Clinical Presentation: We report a 24-year-old man with obstructive hydrocephalus from a tectal glioma, who w as admitted to the hospital for malfunction of a shunt placed 16 years prev iously. Intervention: Magnetic resonance imaging demonstrated enlargement o f the dorsal midbrain associated with increased signal intensity on T2-weig hted images and fluid attenuation inversion recovery (FLAIR) images. No enh ancement occurred with contrast administration. We performed a neuroendosco pic third ventriculostomy and biopsy of the tumor. Histologic examination o f the specimen obtained disclosed a low-grade astrocytoma. No postoperative neurologic complications occurred. Conclusion: FLAIR images were superior to T2-weighted images in demonstrating abnormal intensity in the dorsal mid brain. Neuroendoscopy confirmed a yellowish tumor inferior to the posterior commissure occluding the entrance of the aqueduct, an observation useful i n planning biopsy of the lesion. As the tumor apparently had existed for a number of years, the case supports the notion that the prognosis associated with these tumors is good.