NS-15NEUROSURGICAL MANAGEMENT OF TECTAL GLIOMAS

Abstract

NS-15. NEUROSURGICAL MANAGEMENT OF TECTAL GLIOMAS Andrea Carai1, Antonio Marrazzo2, Vito Andrea dell’Anna2, Alessandro De Benedictis1, Raffaella Messina1, Franco Randi1, Giovanna Stefania Colafati3, Antonella Cacchione2, Evelina Miele2, Angela Mastronuzzi2, and Carlo Efisio Marras1; Department of Neurosciences and Neurorehabilitation, Neurosurgery Unit, Bambino Gesu Children’s Hospital, Rome, Italy; Department of Hematology and Oncology, Bambino Gesu Children’s Hospital, Rome, Italy; Department of Imaging, Neuroradiology Unit, Rome, Italy Tectal gliomas are a rare entity mostly showing an indolent clinical course. However, in some cases progression of disease prompts medical treatment. We report a series of 12 consecutive patients diagnosed with tectal glioma at the Bambino Gesu Children’s Hospital from 2012 to 2016. Diagnosis was made according to typical radiological features. Mean follow-up was 43 months (4 to 75 months). Symptoms at onset were macrocrania and full fontanelle in congenital cases and headache, vomiting, ataxia, postural instability, short term memory and attention difficulties in older children, suggesting a strong role of hydrocephalus. Mean age at diagnosis was 8 years and girls were three times more frequent than boys. Hydrocephalus was present at the timeof the diagnosis virtually inall cases (10/11). In three caseshydrocephalus was congenital but diagnosis of tectal glioma was made 8 years later in one case, due to limited access to MRI imaging at the time of hydrocephalus treatment. Hydrocephalus was treated by endoscopic ventriculostomy in all patients presenting after 2008. We had a major complication in one girl, suffering acute intracranial hypertension with severe outcome 20 months after diagnosis presumably from unexpected ventriculostomy closure. After that, we propose routine positioning of a Rickham ventricular access device in all children with hydrocephalus secondary to tectal gliomas. Three children showed progression of their tectal lesion or gaze disturbances prompting stereotactic needle biopsy to obtain histological diagnosis and start oncological treatment. Surgical resection was never indicated, as large esophytic lesions were not observed in our series. Neuro-Oncology 18:iii127–iii134, 2016. doi:10.1093/neuonc/now078.15 #The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.