Tectal glioma harbors high rates of KRAS G12R and concomitant KRAS and BRAF alterations

Object Electrolyte and endocrinological complications of endoscopic third ventriculostomy (ETV) are infrequent but serious events, likely due to transient hypothalamic-pituitary dysfunction. While the incidence of diabetes insipidus is relatively well known, hyponatremia is not often reported. The authors report on a series of 5 patients with post-ETV hyponatremia. Methods The records of patients undergoing ETV between 2008 and 2010 were reviewed. All ETVs were performed with a rigid neuroendoscope via a frontal bur hole, standard third ventricle floor blunt perforation, Fogarty catheter dilation, and intermittent normal saline irrigation. Postoperative MR images were evaluated for endoscope tract injury as well as the trajectory from the bur hole center to the fenestration site. Results Thirty-two patients (20 male and 12 female) underwent ETV. Their median age was 6 years (range 3 weeks–28 years). Hydrocephalus was most commonly due to nontumoral aqueductal stenosis (43%), nontectal tumor (25%), or tectal glioma (13%). Five patients (16%) had multicystic/loculated hydrocephalus. Five patients (16%) developed hyponatremia between 1 and 8 days following ETV, including 2 patients with seizures (1 of whom was still hospitalized at the time of the seizure and 1 of whom was readmitted as a result of the seizure) and 3 patients who were readmitted because of decline in their condition following routine discharge. No hypothalamic injuries were noted on imaging. Univariate risk factors consisted of age of 2 years or less (p = 0.02), presence of cystic lesions (p = 0.02), and ETV trajectory angle 10° or more from perpendicular (p = 0.001). Conclusions Endoscopic third ventriculostomy is a well-tolerated procedure but can result in serious complications. Hyponatremia is rare and may be more likely in younger patients or those with cystic loculations. Patients with altered craniometry may be at particular risk with a rigid endoscopic approach requiring greater manipulation of subforniceal or hypothalamic structures.

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Management Strategy for Adult Patients with Dorsal Midbrain Gliomas

Neurosurgery ◽

10.1097/00006123-200204000-00009 ◽

2002 ◽

Vol 50 (4) ◽

pp. 735-740 ◽

Cited By ~ 34

Author(s):

David D. Yeh ◽

Ronald E. Warnick ◽

Robert J. Ernst

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Treatment Strategy ◽

Management Strategy ◽

Obstructive Hydrocephalus ◽

Adult Patients ◽

Resonance Imaging ◽

Asymptomatic Patients ◽

Tectal Glioma

Abstract OBJECTIVE: Dorsal midbrain gliomas (DMGs) involving the tectum occur more commonly in children than in adults. These lesions are often indolent in nature, and patients require treatment only for obstructive hydrocephalus. Because limited information is available concerning adults with this type of lesion, we describe our experience and management strategy in adults with DMGs. METHODS: We retrospectively reviewed the charts and magnetic resonance imaging scans of five adult patients (four men, one woman; mean age, 51.6 yr; range, 23–69 yr) who were treated from March 1992 to August 2001 for DMGs involving the tectum. The mean follow-up time for these patients was 71.4 months (range, 25–113 mo). We analyzed the data to determine the optimal treatment strategy and outcomes of patients with DMGs. Tumor volume was analyzed objectively with Scion Image software (Scion Corp., Frederick, MD) to document changes in volume and determine whether treatment strategy differed significantly with tumor size. RESULTS: Tumors in two of these patients were found incidentally, and three others presented with obstructive hydrocephalus. Magnetic resonance imaging scans demonstrated an isolated tectal glioma in one patient, tectal and tegmental (periaqueductal) gliomas in three patients, and a tectal glioma with right thalamic extension in one patient. Treatment consisted of routine follow-up for the two asymptomatic patients and cerebrospinal fluid diversion surgery for the three patients with hydrocephalus. Volumetric analysis demonstrated that all asymptomatic patients had tumors smaller than 9.3 cm3, and symptomatic patients had tumors larger than 28.5 cm3. All follow-up magnetic resonance imaging scans revealed stable dorsal midbrain lesions, and no patient required tumor-specific therapy. CONCLUSION: Although tumors of the dorsal midbrain occur primarily in the pediatric population, similar tumors may occur in adults. As has been learned from experience with children, these lesions are often clinically and radiographically stable and require only appropriate therapy for obstructive hydrocephalus. We advocate a similar conservative strategy of routine imaging follow-up and treatment for hydrocephalus in adult patients. Surgery and other therapy should be reserved for patients with progressive lesions.

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Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

Neurosurgical FOCUS ◽

10.3171/2018.3.focus1850 ◽

2018 ◽

Vol 44 (6) ◽

pp. E15 ◽

Cited By ~ 4

Author(s):

Malte Mohme ◽

Friederike S. Fritzsche ◽

Klaus C. Mende ◽

Jakob Matschke ◽

Ulrike Löbel ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Course ◽

Case Series ◽

Diffuse Astrocytoma ◽

The Mean ◽

Mean Time ◽

Tectal Glioma ◽

Astrocytoma Grade

OBJECTIVETectal gliomas constitute a rare and inhomogeneous group of lesions with an uncertain clinical course. Because these supposedly benign tumors are frequently followed up by observation over many years, the authors undertook this analysis of their own case series in an effort to demonstrate that the clinical course is highly variable and that there is a potential for a progressive biology.METHODSClinical data analysis of 23 cases of tectal glioma (involving 9 children and 14 adults) was performed retrospectively. Radiographic data were analyzed longitudinally and MR images were evaluated for tumor volume, contrast enhancement, and growth progression. Quality of life was assessed using the EORTC BN20 and C30 questionnaires during follow-up in a subgroup of patients.RESULTSThe patients’ mean age at diagnosis was 29.2 years. The main presenting symptom at diagnosis was hydrocephalus (80%). Six patients were treated by primary tumor resection (26.1%), 3 patients underwent biopsy followed by resection (13.1%), and 3 patients underwent biopsy only (13.1%). For additional treatment of hydrocephalus, 14 patients (60.9%) received shunts and/or endoscopic third ventriculostomy. Radiographic tumor progression was observed in 47.9% of the 23 cases. The mean time between diagnosis and growth progression was 51.5 months, and the mean time to contrast enhancement was 69.7 months. Histopathological analysis was obtained in 12 cases (52.2%), resulting in 5 cases of high-grade glioma (3 cases of glioblastoma multiforme [GBM], grade IV, and 2 of anaplastic astrocytoma, grade III), 5 cases of pilocytic astrocytoma, 1 diffuse astrocytoma, and 1 ganglioglioma. Malignant progression was observed in 2 cases, with 1 case progressing from a diffuse astrocytoma (grade II) to a GBM (grade IV) within a period of 13 years. Quality-of-life measurements demonstrated distinct functional deficits compared to a healthy sample as well as glioma control cohorts.CONCLUSIONSAnalysis of this case series shows that a major subpopulation of tectal gliomas show progression and malignant transformation in children as well as in adolescents. These tumors therefore cannot be considered inert lesions and require histological confirmation and close follow-up. Quality-of-life questionnaires show that tectal glioma patients might benefit from special psychological support in emotional, social, and cognitive functionality.

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