Neuro-oncology practice · 2026
Tectal gliomas with "low-grade appearance": Natural history on MR imaging.
СтатьяНазвание и аннотация: Перевод в очереди
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Nasiri Danial, Imwinkelried Lara, Becker Philipp, Raabe Andreas, Schucht Philippe, Wagner Franca, Häni Levin
Аннотация
BACKGROUND: Tectal gliomas (TGs) are often indolent, but heterogeneous study populations in prior cohorts yielded ambiguous results concerning their natural history. We analyzed the natural history of TGs with low-grade appearance on MR imaging.
METHODS: We retrospectively analyzed TGs treated at our institution between 2010 and 2023. We included any space-occupying lesion of the tectum, excluding lesions with nodular contrast enhancement, cystic changes, or primarily pontine or mesencephalic involvement. Volumetric analysis was exclusively based on thin-sliced MRI sequences (≤2 mm). The primary outcome was tumor growth. The secondary outcome was relative annual growth rate (RGR).
RESULTS: Twenty patients met the inclusion criteria (median age 22.5 years, interquartile range [IQR] 18.7-39.6). Headache was the most common indication for imaging (60%). Twelve patients (60%) required cerebrospinal fluid (CSF) diversion for hydrocephalus at the time of diagnosis. These patients did not all present with headaches upon first consultation. Median follow-up was 6.3 years (IQR 2.2-9.8). Median volumetric change from baseline to last follow-up was +3.25% (IQR -10.53 to +28.47%), with a median RGR of 0.87%/year (IQR -1.28 to 11.05%/year). Only 1 patient exhibited tumor growth with a marginal increase in size over 12.8 years of follow-up. Based on MR imaging findings, no malignant transformation occurred in our cohort.
CONCLUSIONS: TG with a low-grade imaging phenotype shows a predominantly stable long-term course. Management is typically limited to CSF diversion for hydrocephalus. Routine tumor-directed therapy is not supported in the absence of concerning clinical or imaging features. Magnetic resonance imaging surveillance remains essential to detect rare progression.
METHODS: We retrospectively analyzed TGs treated at our institution between 2010 and 2023. We included any space-occupying lesion of the tectum, excluding lesions with nodular contrast enhancement, cystic changes, or primarily pontine or mesencephalic involvement. Volumetric analysis was exclusively based on thin-sliced MRI sequences (≤2 mm). The primary outcome was tumor growth. The secondary outcome was relative annual growth rate (RGR).
RESULTS: Twenty patients met the inclusion criteria (median age 22.5 years, interquartile range [IQR] 18.7-39.6). Headache was the most common indication for imaging (60%). Twelve patients (60%) required cerebrospinal fluid (CSF) diversion for hydrocephalus at the time of diagnosis. These patients did not all present with headaches upon first consultation. Median follow-up was 6.3 years (IQR 2.2-9.8). Median volumetric change from baseline to last follow-up was +3.25% (IQR -10.53 to +28.47%), with a median RGR of 0.87%/year (IQR -1.28 to 11.05%/year). Only 1 patient exhibited tumor growth with a marginal increase in size over 12.8 years of follow-up. Based on MR imaging findings, no malignant transformation occurred in our cohort.
CONCLUSIONS: TG with a low-grade imaging phenotype shows a predominantly stable long-term course. Management is typically limited to CSF diversion for hydrocephalus. Routine tumor-directed therapy is not supported in the absence of concerning clinical or imaging features. Magnetic resonance imaging surveillance remains essential to detect rare progression.