Jandhyala Nora R, Negash Bruck, Garcia Mekka R, Allen Jeffrey, Wisoff Jeffrey H, Segal Devorah
Department of Neurology, NYU Langone Health, New York, New York.
Department of Neurosurgery, NYU Langone Health, New York, New York.
J Neurosurg Case Lessons. 2025 Jul 28;10(4). doi: 10.3171/CASE24695.
Small tectal gliomas (TGs) may be unrecognized at initial diagnosis of noncommunicating hydrocephalus, with the etiology typically attributed to idiopathic congenital aqueductal stenosis (CAS). There are 2 published cases of TGs found on follow-up imaging after treatment with endoscopic third ventriculostomy (ETV). The authors investigated for this phenomenon in a large cohort of patients with TG or CAS treated with ETV or CSF shunting.
The authors reviewed records at their institution from 1999 to 2024, identifying 10 patients initially diagnosed with presumed idiopathic CAS and later found to have underlying TG. Of these, 7 were younger than 1 year of age at hydrocephalus presentation. The median time from CAS to glioma diagnosis was 13 months. Reasons for repeat imaging that identified glioma included postoperative surveillance and recurrent hydrocephalus. Five (50%) lesions grew over follow-up, and 2 required chemotherapy.
The authors describe the eventual emergence of TG as a probable cause of hydrocephalus in a cohort of patients initially diagnosed with CAS. As most of these cases were identified incidentally on interval imaging to evaluate adequate function of CSF diversion procedures, follow-up imaging to evaluate for tectal expansion should be considered in children, particularly infants, with a new diagnosis of idiopathic CAS. https://thejns.org/doi/10.3171/CASE24695.
小脑顶盖胶质瘤（TGs）在非交通性脑积水的初始诊断时可能未被识别，其病因通常归因于特发性先天性导水管狭窄（CAS）。有2例经内镜第三脑室造瘘术（ETV）治疗后在随访影像中发现TGs的病例报道。作者在一大群接受ETV或脑脊液分流治疗的TG或CAS患者中研究了这一现象。
作者回顾了其机构1999年至2024年的记录，确定了10例最初诊断为疑似特发性CAS且后来发现患有潜在TG的患者。其中，7例在脑积水出现时年龄小于1岁。从CAS到胶质瘤诊断的中位时间为13个月。发现胶质瘤的重复成像原因包括术后监测和复发性脑积水。5个（50%）病变在随访中增大，2个需要化疗。
作者描述了TG最终出现可能是一组最初诊断为CAS的患者脑积水的原因。由于这些病例大多是在评估脑脊液分流术功能是否充分的间隔成像中偶然发现的，对于新诊断为特发性CAS的儿童，尤其是婴儿，应考虑进行随访成像以评估顶盖是否扩大。https://thejns.org/doi/10.3171/CASE24695 。
