title: Tectal plate tumours. Our experience with a paediatric surgical series.
abstract: BACKGROUND
  Exophytic tectal plate tumours are a particular kind of brain stem tumour that can be treated with microsurgical resection. This paper reports our surgical experience with a paediatric series stressing and underlines the fact that this surgery can be possible because the rate of surgical mortality is low in experienced hands with acceptable morbidity.
  
  
  METHODS
  From 1997 to 2010, 27 patients were treated for exophytic tectal plate tumours. The clinical symptomatology was characterized by an intracranial hypertensive syndrome in 77% of cases, visual disorders in 36% of cases and a Parinaud's syndrome in 12% of cases. All patients were studied using a pre-operative cranio-spinal MRI with and without gadolinium. Hydrocephalus was present in 20 cases treated with a VP shunt in 6 cases and an ETV in the other cases. The surgical removal was total in 60% of cases, partial in 28% of cases and only a large biopsy in 12% of cases. From an histological point of view benign gliomas were diagnosed in 84% of cases and in 16% of cases were classified as WHO grade II and III. Eight patients needed complementary treatment, four with chemotherapy and four with chemotherapy associated to radiotherapy. As a surgical complication two patients had hydrocephalus, one patient had a sub-dural acute haematoma, two patients had an infectious complication requiring surgical treatment and antibiotic therapy, and 5 patients a mechanical shunt dysfunction. No post-surgical mortality was observed.
  
  
  RESULTS
  The most recent results after a median survival of 4.3 years show that 22 patients are still alive while 5 patients died of a progressive disease. Twenty patients in school age continue to follow a normal school programme but 10 patients need assistance.
  
  
  CONCLUSIONS
  Exophytic tectal plate tumours can be treated based on a microsurgical approach in paediatric patients. In experienced hands surgery can be performed with an acceptable morbidity and with zero percent mortality. In our experience, the sub-occipital transtentorial approach permits a wide view of the region and safe surgical removal.
authors.affiliation: Pediatric Service of Neurosurgery Service E, "Pierre Wertheimer" Hospital, 59, boulevard Pinel, 69677 Lyon, France. Electronic address: carmine.mottolese@chu-lyon.fr.
authors.forename: C
authors.initials: C
authors.lastname: Mottolese
authors.affiliation: Pediatric Service of Neurosurgery Service E, "Pierre Wertheimer" Hospital, 59, boulevard Pinel, 69677 Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Szathmari
authors.affiliation: Pediatric Service of Neurosurgery Service E, "Pierre Wertheimer" Hospital, 59, boulevard Pinel, 69677 Lyon, France.
authors.forename: P A
authors.initials: PA
authors.lastname: Beuriat
authors.affiliation: Pediatric Neuro-oncological Service, Leon-Berard Hospital, Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Frappaz
authors.affiliation: Anatomo-Pathological Service, "P. Wertheimer" Hospital, 59, boulevard Pinel, 69677 Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Jouvet
authors.affiliation: Neuroradiological Service "P. Wertheimer" Hospital, 59, boulevard Pinel, 69677 Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Hermier
mesh_terms: D000293:Adolescent; D000368:Aged; D001706:Biopsy / Q000379:methods; D020295:Brain Stem Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D002648:Child; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods
keywords: Abord sous-occipital trans-tentoriel; Brain stem; Exophytic gliomas; Gliome exophytique; Hydrocéphalie triventriculaire; Obstructive hydrocephalus; Sub-occipital transtentorial approach; Tectal plate; Tumeur de la lame quadrijumelle