Surgical Outcomes of Thalamic Tumors in Children: The Importance of Diffusion Tensor Imaging, Neuro-Navigation and Intraoperative Neurophysiological Monitoring

Abstract

BackgroundRecently, modern technology such as diffusion tensor imaging (DTI), neuro-navigation and intraoperative neurophysiological monitoring (IOM) have been actively adopted for the treatment of thalamic tumors. We evaluated surgical outcomes and efficacy of the aforementioned technologies for the treatment of pediatric thalamic tumors.MethodsWe retrospectively reviewed clinical data from 37 children with thalamic tumors between 2004 and 2017. There were 44 operations (27 tumor resections, 17 biopsies). DTI was employed in 17 cases, neuro-navigation in 23 cases and IOM in 14 cases. All diagnoses were revised according to the 2016 World Health Organization Classification of Tumors of the Central Nervous System. Progression-free survival (PFS) and overall survival (OS) rates were calculated, and relevant prognostic factors were analyzed. The median follow-up duration was 19 months.ResultsFifteen cases were gross total resections (GTR), 6 subtotal resections (STR), and 6 partial resections (PR). Neurological status did not worsen after 22 tumor resections. There were statistically significant differences in terms of the extent of resection between the groups with DTI, neuro-navigation and IOM (n=12, GTR or STR=12) and the group without at least one of the three techniques (n=15, GTR or STR=9, p=0.020). The mean PFS was 87.2±38.0 months, and the mean OS 90.7±36.1 months. The 5-year PFS was 37%, and the 5-year OS 47%. The histological grade (p≤0.001) and adjuvant therapy (done vs. not done, p=0.016) were significantly related to longer PFS. The histological grade (p=0.002) and the extent of removal (GTR/STR vs. PR/biopsy, p=0.047) were significantly related to longer OS.ConclusionMaximal surgical resection was achieved with acceptable morbidity in children with thalamic tumors by employing DTI, neuro-navigation and IOM. Maximal tumor resection was a relevant clinical factor affecting OS; therefore, it should be considered the initial therapeutic option for pediatric thalamic tumors.

Thalamic Tumors in a Pediatric Population: Surgical Outcomes and Utilization of High-Definition Fiber Tractography and the Fiber Tracking Technique

“…Radical surgical resection (GTR and STR) was achieved in 50% of our cases, which is comparable to the results of other series [ 3 , 12 , 14 ]. Although we had only 10 cases in our study and the condition of one patient (10%) worsened temporarily, the neurological outcomes of our study were slightly better than those of other studies [ 15 , 16 ]. Our review seems to provide further evidence supporting radical resection of thalamic tumors in the pediatric population.…”

Maximal surgical resection and adjuvant surgical technique to prolong the survival of adult patients with thalamic glioblastoma

“…Fluorescence dye (5-ALA: 5-aminolevulinic acid) was used to discriminate the tumorous lesion in all surgical resection cases. Transcranial motor evoked potential (MEP) and monopolar direct subcortical stimulation (DSS) were used to confirm the intraoperative functional status and the location of the CST [16]. Transcranial MEP was monitored at 60~100 mA every 5 minutes throughout the cortical procedure.…”

Aktuelle Behandlungskonzepte für Hirntumoren im Kindes- und Jugendalter

“…Zusätzlich erleichtert die Anwendung der Neuronavigation basierend auf einem 3-D-MRT-Datensatz die gezielte Planung und sorgfältige Resektion, gerade bei supratentorieller Tumorlokalisation. Die präoperativen Bildbefunde werden zusätzlich intraoperativ durch kontinuierliche Ultraschalluntersuchungen verifiziert und während der Resektion aktualisiert [18].…”