Surgical management of thalamic gliomas: case selection, technical considerations, and review of literature

Kiran, Narayanam Anantha Sai; Thakar, Sumit; Dadlani, Ravi; Mohan, Dilip; Furtado, Sunil V.; Ghosal, Nandita; Aryan, Saritha; Hegde, Alangar S.

doi:10.1007/s10143-013-0452-3

Cited by 44 publications

(38 citation statements)

References 39 publications

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“…Regarding the radiological control, there was a statistical significance between lesion control and microsurgery in this study as p value = 0.03. This was agreed by Sai Kiran et al who concluded that radical resection results in the improvement of clinical condition as well as tumor control in majority of the patients with thalamic tumors [25].…”

Section: Discussionsupporting

confidence: 69%

Different strategies in the management of thalamic space-occupying lesions

Fayed¹,

Aziz²,

Eshra³

2020

Egypt J Neurosurg

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Introduction: Thalamic space-occupying lesions (SOL) are considered challenging for microsurgical removal. Unfortunately, the pathological features of lesions occurring in the thalamic region are different with a wide variation in clinical behavior and outcome. Although microsurgery is still the gold standard in the management of these lesions through different approaches, questions remain whether surgery is feasible and safe in these patients and what are the alternatives? It is well known that stereotactic techniques may be favorable especially in cystic, small, multiple lesions and in combination with adjuvant therapy. Transventricular endoscopic approach is also an alternative technique to combine tumor biopsy and treatment of hydrocephalus. Aim of the study: The identification of the different procedures for the management of thalamic SOL in respect to the age of the patient, the clinical condition, and the site of the lesion as well as its extent and pathology. Patients and methods: This prospective study included 35 patients having thalamic lesions with a mean age of 27 years old who were treated with different approaches including microsurgical, stereotactic, and endoscopic approaches. The clinical outcome was assessed as the same, improved, deteriorated, or died in comparison to the initial clinical status, while the radiological control was measured as no gross residual, residual < 10% and residual > 10%. Chi-square test was used to test the association between two categorical variables. Results: Thirty-five patients were included in this study, 20 were males and 15 were females. Eight cases were children, and 27 cases were adults. The most common clinical presentation was contralateral hemiparesis. The most common pathology was pilocytic astrocytoma. Radiological studies showed that the total thalamic type was the most common topographic variant and that 10 cases had hydrocephalus treated with CSF diversion procedures. For the definitive lesion, 2 cases underwent endoscopic biopsy and cystoventriculostomy and 18 cases had stereotactic technique in the form of biopsy, aspiration, and ommaya reservoir application, while 15 cases had microsurgery through different approaches with stereotactic technique preceding surgery in 2 of them. Conclusion: The main factors involved in choosing the appropriate approach included nature of the lesion (solid or cystic, multiplicity), suspected pathological type, and diffusion tensor imaging. Abscesses are best treated with stereotaxy, while non-neoplastic cystic lesions (other than abscesses) related to the ventricles are best treated with endoscopy. For the remaining pathologies, maximum surgical removal is the best management. Best lesion control was provided by microsurgery.

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Section: Discussionsupporting

confidence: 69%

Different strategies in the management of thalamic space-occupying lesions

Fayed¹,

Aziz²,

Eshra³

2020

Egypt J Neurosurg

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“…halamic tumors are relatively uncommon: they account for approximately 1%-5% of all brain tumors in children, 3,6,9,12,29,31,32,37 although differences in nomenclature and a limited number of exclusively pediatric series make it difficult to quantify. In the past, the outcome of surgical treatment for thalamic tumors was poor.…”

mentioning

confidence: 99%

Surgical treatment of thalamic tumors in children

Cinalli¹,

Aguirre²,

Mirone³

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEIn the past, the outcome of surgical treatment for thalamic tumor was poor. These lesions were often considered inoperable. However, contemporary microsurgical techniques, together with improvements in neuroimaging that enable accurate presurgical planning, allow resection to be accomplished in a safer way.METHODSThe medical records, imaging studies, and operative and pathology reports obtained for pediatric patients who were treated for thalamic tumors at the authors’ department were reviewed. Neuronavigation and intraoperative monitoring of motor and somatosensory evoked potentials were used. Preoperative tractography, which helped to identify internal capsule fibers, was very important in selecting the surgical strategy. Postoperatively, an MRI study performed within 24 hours was used to assess the extent of tumor resection as partial (≤ 90%), subtotal (> 90%), or gross total (no residual tumor).RESULTSSince 2002, 27 children with thalamic tumors have been treated at the authors’ department. There were 9 patients with unilateral thalamic tumors, 16 with thalamopeduncular tumors, and 2 with a bilateral tumor. These last 2 patients underwent endoscopic biopsy and implantation of a ventriculoperitoneal shunt. Thirty-nine tumor debulking procedures were performed in the remaining 25 patients. Different surgical approaches were chosen according to tumor location and displacement of the posterior limb of the internal capsule (as studied on axial T2-weighted MRI) and corticospinal tract (as studied on diffusion tensor imaging with tractography, after it became available). In 12 cases, multiple procedures were performed; in 7 cases, these were done as part of a planned multistage resection. In the remaining 5 cases, the second procedure was necessary because of late recurrence or regrowth of residual tumor.At the end of the surgical phase, of 25 patients, 15 (60%) achieved a gross-total resection, 4 (16%) achieved a subtotal resection, and 6 (24%) achieved a partial resection. Eighteen patients harbored low-grade tumors in our series. In this group, the mean follow-up was 45 months (range 4–132 months). At the end of follow-up, 1 patient was dead, 12 patients were alive with no evidence of disease, 4 patients were alive with stable disease, and 1 was lost to follow-up. All patients were independent in their daily lives. The outcome of high-grade tumors in 9 patients was very poor: 2 patients died immediately after surgery, 6 died of progressive disease, and 1 was alive with residual disease at the time of this report.CONCLUSIONSThis institutional review seems to offer further evidence in favor of attempts at radical resection in pediatric patients harboring unilateral thalamic or thalamopeduncular tumors. In low-grade gliomas, radical resection in a single or staged procedure can be curative without complementary treatment. Recurrences or residual regrowth can be safely managed surgically. In high-grade tumors, the role of and opportunity for radical or partial resection remains a matter of debate.

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“…This is not surprising if we consider that Krieg 21 . The PLIC can be easily localised by intraoperative subcortical mapping while pre-operative DTI of the CST can occasionally be difficult due to tumor infiltration of the white matter 23 .…”

Section: Discussionmentioning

confidence: 73%

“…In the literature, there are few publications which address this question. Some papers describe satisfactory results in the resection of grade I thalamic astrocytomas which most typically affect children 12,13,20,21 . Thus, in this category of patients the surgical indication to resection is generally clear.…”

Section: Discussionmentioning

confidence: 98%