Forniceal glioma in children. Clinical article.
OBJECTIVE
Five to ten percent of pediatric brain tumors are located in the ventricles. Among them, forniceal lesions are rare and their management has not often been described. The aim of this study was to review the clinical, radiological, and histopathological features as well as the feasibility of surgical excision and the outcomes in these patients.


METHODS
From a retrospective analysis of 250 cases of supratentorial pediatric glioma, the records of 8 children presenting with forniceal lesions were selected and reviewed.


RESULTS
The median age of patients in the cohort was 13.5 years. Presenting features included intracranial hypertension (7 cases), hypothalamic dysfunction (2), and memory dysfunction (3). Complete resection was possible in only 1 case, where the lesion was mainly exophytic; the remaining patients had either a partial resection or biopsy. On histological review, the tumors were confirmed as pilocytic astrocytoma (4 lesions), WHO Grade II astrocytoma (3), and ganglioglioma (1). Postoperatively, working and retrograde memory was normal for all patients, but the authors found a mild alteration in verbal episodic memory in 5 patients. Despite fatigability for 5 patients, academic achievement was normal for all but 2, both of whom had preoperative school difficulties. Additional treatment was required for 5 patients for tumor progression, with a median interval of 19 months from surgery. At a median follow-up duration of 4.9 years, all patients had stable disease.


CONCLUSIONS
In this series, forniceal gliomas were found to be low-grade gliomas. They are surgically challenging, and only exophytic lesions may be cured surgically. Due to the high rate of progression of residual disease, adjuvant therapy is recommended for infiltrative tumors, and it yielded excellent results.
Blauwblomme
Thomas
T
Departments of Neurosurgery Hôpital Necker Enfants Malades, Université Paris Descartes, Paris.
Varlet
Pascale
P
Goodden
John R
JR
Cuny
Marie Laure
ML
Piana
Helene
H
Roujeau
Thomas
T
Dirocco
Federico
F
Grill
Jacques
J
Kieffer
Virginie
V
Boddaert
Nathalie
N
Sainte-Rose
Christian
C
Puget
Stéphanie
S
D000293:Adolescent; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000523:psychology / Q000601:surgery*; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D020712:Fornix, Brain; D005910:Glioma / Q000175:diagnosis* / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D008568:Memory; D012189:Retrospective Studies; D016896:Treatment Outcome