Pediatric thalamic incidentalomas: an international retrospective multicenter study

Abstract

OBJECTIVE Widespread use of modern neuroimaging has led to a surge in diagnosing pediatric brain incidentalomas. Thalamic lesions have unique characteristics such as deep location, surgical complexity, and proximity to eloquent neuronal structures. Currently, the natural course of incidental thalamic lesions is unknown. Therefore, the authors present their experience in treating such lesions. METHODS A retrospective, international multicenter study was carried out in 8 tertiary pediatric centers from 5 countries. Patients were included if they had an incidental thalamic lesion suspected of being a tumor and were diagnosed before the age of 20 years. Treatment strategy, imaging characteristics, pathology, and the outcome of operated and unoperated cases were analyzed. RESULTS Overall, 58 children (23 females and 35 males) with a mean age of 10.8 ± 4.0 years were included. The two most common indications for imaging were nonspecific reasons (n = 19; e.g., research and developmental delay) and headache unrelated to small thalamic lesions (n = 14). Eleven patients (19%) underwent early surgery and 47 were followed, of whom 10 underwent surgery due to radiological changes at a mean of 11.4 ± 9.5 months after diagnosis. Of the 21 patients who underwent surgery, 9 patients underwent resection and 12 underwent biopsy. The two most frequent pathologies were pilocytic astrocytoma and WHO grade II astrocytoma (n = 6 and n = 5, respectively). Three lesions were high-grade gliomas. CONCLUSIONS The results of this study indicate that pediatric incidental thalamic lesions include both low- and high-grade tumors. Close and long-term radiological follow-up is warranted in patients who do not undergo immediate surgery, as tumor progression may occur.

The Clinical Applications of Liquid Biopsies in Pediatric Brain Tumors: A Systematic Literature Review

“…Similar results are available for pediatric MB, which can be successfully detected and monitored with liquid biopsy [ 13 , 16 ]. Preferably, liquid biopsy could replace biopsy for any PBT, which would be especially useful in incidentalomas [ 19 , 42 , 43 ]. So far, however, ct-DNA extraction has proven to be difficult in low-grade PBT and no standardized or reliable measurements for PBTs in general are available yet [ 19 ].…”

Surgical Treatment of Pediatric Incidentally Found Brain Tumors: A Single-Center Experience

“…The present study focused only on pediatric patients (age at diagnosis < 18 years) treated with initial surgical excision of a space-occupying incidental mass within the brain. An incidental finding, also referred to as an incidentaloma, was defined as a spaceoccupying lesion found on brain-imaging studies performed for an unrelated condition (e.g., trauma or behavior changes) with a radiological appearance suggestive of a tumor in an asymptomatic patient [5,15]. Patients who were initially treated surgically (without a prior conservative approach) with complete clinical data and at least 12 months of postoperative follow-up were included in the study.…”

“…Incidentally found brain tumors, also referred to as incidentalomas, account for 0.2-5.7% of all incidental intracranial findings, with an estimated prevalence of 0.04-0.18% [1,3,4]. These lesions are defined as asymptomatic intracranial space-occupying lesions, and their radiological appearance is highly indicative of brain tumors [5]. The majority of pediatric incidentalomas are low-grade gliomas (LGG) [6].…”

Torcular pseudomass in a 14-month-old child: illustrative case

“…1 However, other incidentalomas, such as torcular pseudomass, may constitute a diagnostic dilemma in the pediatric age group. [2][3][4] Moreover, the worrisome radiographic characteristics may prompt unnecessary tests and procedures. 1 We present a case of a 14-month-old girl who presented with postvaccination fever, first-time seizure, and a CT finding concerning for epidural abscess.…”

“… 1 However, other incidentalomas, such as torcular pseudomass, may constitute a diagnostic dilemma in the pediatric age group. 2–4 Moreover, the worrisome radiographic characteristics may prompt unnecessary tests and procedures. 1 …”