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

Object. Tectal plate gliomas are generally low-grade astrocytomas with favorable prognosis, and observation of the lesion and management of hydrocephalus remain the mainstay of treatment. Methods. A cohort of patients with tectal plate gliomas at 2 academic institutions was retrospectively reviewed. Results. Forty-four patients with a mean age of 10.2 years who harbored tectal plate gliomas were included in the study. The mean clinical and radiological follow-up was 7.6 +/- 3.3 years (median 7.9 years, range 1.5-14.7 years) and 6.5 +/- 3.1 years (median 6.5 years, range 1.1-14.7 years), respectively. The most frequent intervention was CSF diversion (81.8% of patients) followed by biopsy (11.4%), radiotherapy (4.5%), chemotherapy (4.5%), and resection (2.3%). On MR imaging tectal plate gliomas most commonly showed T1-weighted isointensity (71.4%), T2-weighted hyperintensity (88.1%), and rarely enhanced (19%). The initial mean volume was 1.6 +/- 2.2 cm(3) and it increased to 2.0 +/- 4.4 cm(3) (p = 0.628) at the last follow-up. Frontal and occipital horn ratio (FOUR) and third ventricular width statistically decreased over time (p < 0.001 and p < 0.05, respectively). Conclusions. The authors' results support existing evidence that tectal plate gliomas frequently follow a benign clinical and radiographic course and rarely require any intervention beyond management of associated hydrocephalus.