The role of neuroendoscopy in the management of tectal gliomas

Objectives: The objective was to determine the role of neuroendoscopy in the management of tectal plate gliomas. Methods: Clinical and radiological data of children and adults who underwent neuroendoscopy were reviewed. Successful outcome was defined as shunt-freedom and resolution of symptoms and signs of raised intracranial pressure. Results: Between 1 April 1998 and 31 March 2003, 11 patients (6 males and 5 females) underwent endoscopic third ventriculostomy (ETV) for the management of hydrocephalus secondary to a tectal plate glioma. This comprises 4% of 258 patients who have undergone neuroendoscopic procedures in our unit. The median age at the time of surgery was 19 (range 9-59) years. In 4 patients endoscopic biopsy of the tumour was performed at the same time. During a median follow-up period of 31 months (range 2-45), 4 patients underwent a second ETV, of whom 2 subsequently required insertion of ventriculoperitoneal (VP) shunts. Nine patients (82%) remain shunt-independent. Of the 4 tumours that were biopsied, a histological diagnosis of low-grade astrocytoma was made with certainty in only 2 cases. All tumours remained unchanged on follow-up MR imaging. Conclusions: Endoscopic third ventriculostomy can result in excellent control of hydrocephalus in patients with tectal plate gliomas. Tectal gliomas appear to be very slow growing tumours that can be managed conservatively in adults as well as children. Longer follow-up in larger studies is required.