Ann Clin Neurophysiol.  2021 Apr;23(1):56-60. 10.14253/acn.2021.23.1.56.

Tectal glioma presenting with adult-onset epileptic seizures

• Kim JH
• Jo H
• Choi JW
• Joo EY

• KMID: 2515609
• DOI: http://doi.org/10.14253/acn.2021.23.1.56

Abstract

Tectal glioma is an indolent and benign tumor that occurs predominantly in the pediatric population. It arises in the tectum of the midbrain and, due to its location, contributes to the development of obstructive hydrocephalus, typically presenting with increased intracranial pressure (IICP) symptoms or signs. Here we report a rare case of tectal glioma that presented as adult-onset epileptic seizures without IICP symptoms and was treated with endoscopic third ventriculostomy and antiepileptic drugs.

Keyword

Tectal glioma; Hydrocephalus; Epilepsy

Figure

• 

  Fig. 1. Electroencephalogram showing preoperative interictal epileptiform discharges. Sharp waves in the right anterior temporal area (F8 or F8T8) were observed with a frequency of once every 5-10 seconds (red arrowheads). Intermittent slowing could also be seen in the right temporal area.

• 

  Fig. 2. Ictal electroencephalogram (EEG) during an automotor seizure. Irregular theta rhythms in the right anterior temporal area were followed by rhythmic theta-band activities in the right hemisphere (frontotemporal maximum). The electrocardiogram showed ictal tachycardia. This EEG was accompanied by motionless staring and lip smacking, and lasted 58 seconds.

• 

  Fig. 3. Brain magnetic resonance imaging (MRI) of the patient. (A) Preoperative sagittal gadolinium-enhanced T1-weighted image (right) showing a 0.7-cm-diameter nonenhancing nodular lesion (arrowhead) obstructing the cerebral aqueduct. Coronal fluid-attenuated inversion recovery (FLAIR) (middle) and axial FLAIR (left) images show high signal intensities in both anterior temporal areas, and bilaterally enlarged lateral and temporal ventricles. (B) Postoperative 3-month follow-up sagittal gadolinium-enhanced T1-weighted imaging (right) showing no change in the size of the nodular lesion (arrowhead). However, coronal (middle) and axial FLAIR (left) images show decreased signal intensities in both anterior temporal areas and reduced ventricle sizes compared with preoperative images. (C) Postoperative 8-months follow-up noncontrast MRI of the brain. The images show no improvement in the size of the nodular lesion (arrowhead), the size of the ventricles, or the high signal intensity in both anterior temporal areas compared with the postoperative 3-months follow-up images.

Reference

1. Hosking GP. Fits in hydrocephalic children. Arch Dis Child. 1974; 49:633–635.

2. Phi JH, Kim SK, Kang TH, Wang KC. Hydrocephalic fits: forgotten but not gone. Childs Nerv Syst. 2012; 28:1863–1868.

3. Dabscheck G, Prabhu SP, Manley PE, Goumnerova L, Ullrich NJ. Risk of seizures in children with tectal gliomas. Epilepsia. 2015; 56:e139–e142.

4. Igboechi C, Vaddiparti A, Sorenson EP, Rozzelle CJ, Tubbs RS, Loukas M. Tectal plate gliomas: a review. Childs Nerv Syst. 2013; 29:1827–1833.

5. Reyes-Botero G, Mokhtari K, Martin-Duverneuil N, Delattre JY, Laigle-Donadey F. Adult brainstem gliomas. Oncologist. 2012; 17:388–397.

6. Liu APY, Harreld JH, Jacola LM, Gero M, Acharya S, Ghazwani Y, et al. Tectal glioma as a distinct diagnostic entity: a comprehensive clinical, imaging, histologic and molecular analysis. Acta Neuropathol Commun. 2018; 6:101.

7. Lapras C, Bognar L, Turjman F, Villanyi E, Mottolese C, Fischer C, et al. Tectal plate gliomas. Part I: microsurgery of the tectal plate gliomas. Acta Neurochir (Wien). 1994; 126:76–83.

8. Li KW, Roonprapunt C, Lawson HC, Abbott IR, Wisoff J, Epstein F, et al. Endoscopic third ventriculostomy for hydrocephalus associated with tectal gliomas. Neurosurg Focus. 2005; 18:E2.

9. Heo K. Sleep and epilepsy. J Korean Sleep Res Soc. 2009; 6:69–73.