Tectal plate gliomas are low-grade, benign neoplastic lesions arising predominately in children. The tumor comprises 10-20% of all brain tumors in the pediatric population. They are of neural crest embryological origin and develop from glial cells in the brainstem. This form of astrocytoma is usually spontaneous, with no known associated environmental or genetics risk factors. However, an association between Neurofibromatosis Type 1 and brain stem gliomas have been found.
Symptoms are non-specific and characteristically include a history of headaches from intracranial hypertension secondary to obstruction of cerebral spinal fluid (CSF) in the ventricles. In addition, vomiting, nausea, visual disturbances, such as Parinaud Syndrome, auditory and balance deficits may be present as a result of pyramidal tract dysfunction. The proximity of the tectal plate to the aqueduct of Sylvius in the mesencephalon makes non-communicating hydroencephalus the most likely culprit for the increased intracranial pressure.
Diagnosis of tectal plate glioma is based
…show more content…
Ventriculoperitoneal shunts, which reroute CSF to the abdomen and endoscopic third ventriculostomy, which places a fenestration on the floor of the third ventricle and allows for CSF to directly flow into the subarachnoid space, are both viable choices for management of hydroencephalus. Endoscopic third ventriculostomy has the additional advantage of obtaining a biopsy during the same procedure, allowing for staging of the tumor and consequently, better-informed decisions on treatment. If tumor progression or high-grade gliomas are identified after the initial intervention, patients can elect to undergo a mixed combination of more aggressive treatments, such as surgical resection of the tumor, radiotherapy, and