Neuroendoscopic Biopsy of Tectal Glioma: A Case Report

 

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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 cerebrospinal fluid diversion and biopsy. Clinical Presentation: We report a 24-year-old man with obstructive hydrocephalus from a tectal glioma, who was admitted to the hospital for malfunction of a shunt placed 16 years previously. Intervention: Magnetic resonance imaging demonstrated enlargement of the dorsal midbrain associated with increased signal intensity on T2-weighted images and fluid attenuation inversion recovery (FLAIR) images. No enhancement occurred with contrast administration. We performed a neuroendoscopic third ventriculostomy and biopsy of the tumor. Histologic examination of 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 midbrain. Neuroendoscopy confirmed a yellowish tumor inferior to the posterior commissure occluding the entrance of the aqueduct, an observation useful in 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.

References

• 1 Barkovich A J, Newton T H. MR of aqueductal stenosis: evidence of a broad spectrum of tectal distortion.  AJNR. 1989;  10 471-476
  PubMedGoogle Scholar
• 2 Grant J A, McLone D G. Third ventriculostomy: a review.  Surg Neurol. 1997;  47 210-212
  CrossrefPubMedGoogle Scholar
• 3 Hoffman H J, Harwood-Nash D, Gilday D L. Percutaneous third ventriculostomy in the management of noncommunicating hydrocephalus.  Neurosurgery. 1980;  7 313-321
  PubMedGoogle Scholar
• 4 Kobayashi N, Kamikawa S, Miyake S, Yamamoto K, Kojima N, Tamaki N. Treatment of hydrocephalus without shunt placement: third ventriculostomy.  Neurol Surgery. 1997;  25 35-40
  PubMedGoogle Scholar
• 5 Lapras C, Bognar L, Turjman F, Villanyi E, Mottolese C, Fischer C, Jouvet A, Guyotat J. Tectal plate gliomas. Part I: Microsurgery of the tectal plate gliomas.  Acta Neurochir. 1994;  126 76-83
  CrossrefPubMedGoogle Scholar
• 6 May P L, Blaser S I, Hoffman H J, Humphreys R P, Harwood-Nash D C. Benign intrinsic tectal “tumors” in children.  J Neurosurg. 1991;  74 867-871
  PubMedGoogle Scholar
• 7 Oka K, Yamamoto K, Ikeda K, Tomonaga M. Flexible endoneurosurgical therapy for aqueductal stenosis.  Neurosurgery. 1993;  33 236-242
  CrossrefPubMedGoogle Scholar
• 8 Pendl G, Vorkapic P, Koniyama M. Microsurgery of midbrain lesions.  Neurosurgery. 1990;  26 641-648
  PubMedGoogle Scholar
• 9 Pendl G, Vorkapic P. Microsurgery of intrinsic midbrain lesions.  Acta Neurochir Supplementum. 1991;  53 137-143
  PubMedGoogle Scholar
• 10 Pollack I F, Pang D, Albright A L. The long-term outcome in children with late-onset aqueductal stenosis resulting from benign intrinsic tectal tumors.  J Neurosurg. 1994;  80 681-688
  CrossrefPubMedGoogle Scholar
• 11 Raffel C, Hudgins R, Edwards M S. Symptomatic hydrocephalus: initial findings in brainstem gliomas not detected on computed tomographic scans.  Pediatrics. 1988;  82 733-737
  PubMedGoogle Scholar
• 12 Sanford R A, Bebin J, Smith R W. Pencil gliomas of the aqueduct of Sylvius. Report of two cases.  J Neurosurg. 1982;  57 690-696
  PubMedGoogle Scholar
• 13 Shamoto H, Shirane R, Ogawa A, Yoshimoto T. A case of tectal glioma.  Neurol Surgery. 1993;  21 1055-1059
  PubMedGoogle Scholar
• 14 Sola J, Arcas I, Martinez-Lage J F, Martinez Perez M, Esteban J A, Poza M. Astrocytoma of the cerebral aqueduct.  Childs Nerv Syst. 1987;  3 294-296
  CrossrefPubMedGoogle Scholar
• 15 Steinbok P, Boyd M C. Periaqueductal tumor as a cause of late-onset aqueductal stenosis.  Childs Nerv Syst. 1987;  3 170-174
  CrossrefPubMedGoogle Scholar
• 16 Stroink A R, Hoffman H J, Hendrick E B, Humphreys R P. Diagnosis and management of pediatric brain-stem gliomas.  J Neurosurg. 1986;  65 745-750
  PubMedGoogle Scholar

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Corresponding Author

Ph.D. M.D. Takanori Inamura

Department of Neurosurgery Neurological Institute Faculty of Medicine Kyushu University

3-1-1 Maidashi

Higashi-ku

Fukuoka, 812-8582

Japan

Phone: +81-92-642-5524

Fax: +81-92-642-5526

Email: taka@ns.med.kyushu-u.ac.jp