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Jessica Ternier, Alison Wray, Stéphanie Puget, Nathalie Bodaert, Michel Zerah, and Christian Sainte-Rose

B rainstem lesions represent 10 to 25% of brain tumors in children, with 5% of these lesions located in the tectal plate. This unique subgroup differs from other brainstem lesions in nature, presentation, and clinical course. 12 The nature of these lesions varies from hamartomas of the tectal plate associated with aqueductal stenosis to true focal indolent midbrain tumors. The few reports available confirm that both malformative and neoplastic lesions are found in this area. At the time of diagnosis, clinical features usually do not help in

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Paul L. May, Susan I. Blaser, Harold J. Hoffman, Robin P. Humphreys, and Derek C. Harwood-Nash

features is therefore important in determining the prognosis of the identifiable subgroups. Previous reports of periaqueductal and tectal tumors have shown an overall poor prognosis with few patients surviving longer than 18 months. 19 More recently, however, a group of indolent tectal gliomas has been described, 3 although we believe those tumors to be clinically and radiologically different from our series. We present six children as an example of a small but important subgroup of patients with benign brain-stem tumors that can be managed with cerebrospinal fluid

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Ahmed M. Alkhani, Frederick A. Boop, and James T. Rutka

, dorsally exophytic brainstem, and cervico-medullary and benign intrinsic tectal astrocytoma subtypes. 8, 13, 18, 22 With the exception of the diffuse intrinsic and some focal pontine astrocytomas, brainstem astrocytomas in children are usually benign low-grade neoplasms. 18 Since the description of tectal astrocytomas as “pencil gliomas” by Sanford, et al., 20 benign intrinsic tectal tumors have come to be recognized as indolent, slow-growing lesions that occlude the aqueduct of Sylvius, producing obstructive triventricular hydrocephalus. In the majority of children

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Kazunari Oka, Yoshiaki Kin, Yoshinori Go, Yushi Ueno, Katsuyuki Hirakawa, Masamichi Tomonaga, Tohru Inoue, and Susumu Yoshioka

T ectal tumors are very rare. 1, 2, 4–16 To date, there has been no review of neuroendoscopic treatment for tectal tumors based on minimally invasive surgery. The clinical features of tectal tumors are summarized as follows: although the appearance of neurological deficits is infrequent in patients who harbor tectal tumors, symptoms related to obstructive hydrocephalus occur early in the development of the disease. The advent of magnetic resonance (MR) imaging has facilitated the clinicopathological evaluation of these disorders. We have favored the treatment

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Christoph J. Griessenauer, Elias Rizk, Joseph H. Miller, Philipp Hendrix, R. Shane Tubbs, Mark S. Dias, Kelsie Riemenschneider, and Joshua J. Chern

B rainstem gliomas account for 10%–20% of pediatric primary brain tumors. Tectal plate gliomas are a subgroup of focal brainstem gliomas that typically present with obstructive hydrocephalus secondary to enlargement of the tectal plate and obstruction of the cerebral aqueduct. Patients frequently have a long-standing history of headaches. Additional symptoms include visual abnormalities such as Parinaud syndrome and oculomotor palsy, balance problems, and nausea and vomiting. 11 , 16 , 22 Several case series have reported on the long-term outcome of

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Georges Rodesch, Bernard Otto, Micheline Mouchamps, and Jacques Born

of an adult patient with CM-I and syringomyelia associated with a tectal AVM, both of which resolved spontaneously after endovascular treatment of the vascular malformation. Case Report Presentation and Examination This 21-year-old woman presented to the Department of Neurosurgery because of headaches and intermittent sensations of loss of equilibrium. She had been seen by an ophthalmologist for episodes of strabismus unrelated to the headaches. Her medical history was remarkable for premature birth (at 6 months' gestation), although she did not

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Neurosurgical Forum: Letters to the Editor To The Editor Neil Buxton , F.R.C.S.(Edin) Iain Robertson , F.R.C.S.(Edin) University Hospital Nottingham, United Kingdom 152 153 We read with considerable interest the paper by Oka, et al. (Oka K, Kin Y, Go Y, et al: Neuroendoscopic approach to tectal tumors: a consecutive series. J Neurosurg 91: 964–970, December, 1999) on the neuroendoscopic approach to tectal tumors and congratulate them on their success with the technique. We also have some experience with neuroendoscopic third ventriculostomy (NTV). 1 We

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Timothy H. Ung, Christopher Kellner, Justin A. Neira, Shih-Hsiu J. Wang, Randy D’Amico, Phyllis L. Faust, Peter Canoll, Neil A. Feldstein, and Jeffrey N. Bruce

T he quadrigeminal plate, also known as the tectum, is embryonically derived from the alar plate of the neural tube and contains auditory and visual reflex pathways. 12 The position of the superior colliculi, inferior colliculi, and the close proximity of the cerebral aqueduct leave this anatomical region susceptible to lesional disruption of visual and auditory pathways as well as interruption of normal CSF flow. 12 Patients harboring lesions within the tectal plate commonly present with obstructive hydrocephalus secondary to occlusion of the cerebral

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Hussam Abou-Al-Shaar, Timothy G. White, Ivo Peto, and Amir R. Dehdashti

Transcript Here we present the surgical treatment of a symptomatic tectal cavernous malformation in a 64-year-old man who is known for this lesion for several years. However, he presented recently with an episode of bleeding resulting in dysmetria and right-sided weakness. He also presented about a week before transfer to our center with a new left-sided third nerve palsy, which is quite significant, almost a complete palsy. Imaging revealed a new hemorrhage in the brainstem cavernous malformation in the tectal region, as you can see, in this axial T2 imaging

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Ian F. Pollack, Dachling Pang, and A. Leland Albright

some instances, radical surgery alone is effective in producing long-term disease control. In comparison to the above categories of brain-stem tumors, which generally demonstrate relentless progression unless adequately treated, gliomas of the tectal plate have been reported to be particularly indolent, often remaining stable in size for several years; 7, 8, 26, 32 the majority of the lesions that were examined histopathologically have been described as low-grade glial neoplasms. These intrinsic tectal tumors characteristically present with late-onset aqueductal