NS-15: NEUROSURGICAL MANAGEMENT OF TECTAL GLIOMAS

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 Gesù 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 time of the diagnosis virtually in all cases (10/11). In three cases hydrocephalus 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.