<p>The tectal plate can be affected by a broad spectrum of pathological processes, resulting in diverse clinical manifestations. These include primary or metastatic tumors, granulomatous diseases, cerebrovascular malformations, ischemic insults, traumatic injury, lipomas, cysticercosis, and degenerative disorders. However, isolated tectal thickening is typically not regarded as a pathological entity and remains insufficiently investigated. This study retrospectively analyzed the clinical and radiological features of 50 patients presenting to the Ankara University Faculty of Medicine between 2012 and 2023 who exhibited tectal thickening on neuroimaging. The objective was to evaluate the association between tectal thickness and clinical symptoms, as well as related radiological pathologies. Clinical data and imaging findings were assessed to investigate correlations between tectal thickening and conditions such as hydrocephalus, Chiari II malformation, syringomyelia, and cerebral atrophy. Statistical analyses were performed to delineate the clinical significance of increased tectal thickness and to explore its potential role in diagnosis and management. All 50 patients demonstrated tectal thickening, with hydrocephalus identified in 76% of cases. Tectal thickness was significantly greater in patients with Chiari II malformation and syringomyelia. However, tectal thickening did not have a statistically significant effect on the area of the cerebral aqueduct. No association was observed between tectal thickening and visual or auditory symptoms. The risk of malignant transformation was found to be low. This study demonstrates a significant association between increased tectal thickness, hydrocephalus, and specific craniospinal pathologies. These findings suggest that tectal thickening may represent a relevant radiological feature associated with distinct clinical and imaging characteristics, warranting further investigation in larger prospective studies.</p>