Survival and functional outcomes in paediatric thalamic and thalamopeduncular low grade gliomas

Beneš, Vladimı́r; Zápotocký, Michal; Libý, Petr; Táborský, Jakub; Blažková, Jana; Sumerauer, David; Mišove, Adéla; Perníková, Ivana; Kynčl, Martin; Krsková, Lenka; Koblížek, Miroslav; Zámečnı́k, Josef; Bradáč, Ondřej; Tichý, Michal

doi:10.1007/s00701-021-05106-5

Cited by 7 publications

(5 citation statements)

References 44 publications

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“…Historically, a fully conservative approach was usually chosen, with stereotactic biopsy once deemed the only safe surgical procedure for many thalamic gliomas [14]. While…”

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Paediatric Thalamic Gliomas—Single-Centre Experience

Krahulik,

Blazek,

Halaj

et al. 2024

Brain Sciences

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The surgical treatment of paediatric thalamic gliomas has been burdened with high morbidity, and these lesions were often considered inoperable. With new approaches and intraoperative technologies, we can remove tumours once deemed inoperable. In our single centre, we have operated on 11 paediatric patients over the course of 8 years. We have performed eight GTR resections and three intended subtotal resections. The postoperative neurological deficit ranged from mild to very severe for motor weakness and none to severe for aphasia after surgery, with all of the patients improving at 3-month follow-up. Radicality in the surgical approach to thalamic gliomas in children has shown significant benefits when compared to more conservative approaches. For children with LGGs, extensive surgical resection is associated with improved prognosis and longer progression-free survival. However, it does not yield the same proportional benefit for HGGs due to its aggressive nature and worse outlook.

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“…Historically, a fully conservative approach was usually chosen, with stereotactic biopsy once deemed the only safe surgical procedure for many thalamic gliomas [14]. While…”

Section: Discussionmentioning

confidence: 99%

“…Historically, a fully conservative approach was usually chosen, with stereotactic biopsy once deemed the only safe surgical procedure for many thalamic gliomas [14]. While biopsy aids in obtaining tissue samples [15], determining the tumour's grade and guiding the subsequent treatment, it does not provide a complete curative means.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Paediatric Thalamic Gliomas—Single-Centre Experience

Krahulik,

Blazek,

Halaj

et al. 2024

Brain Sciences

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“…According to the literature [17,18], due to the very low mortality rate of this condition and the rare possibility of undergoing malignant transformation, in low-grade thalamopeduncular tumors, we suggest maximizing tumor resection as the treatment of choice. The cornerstone of treatment of these lesions is surgery, even in cases of tumor regrowth.…”

Section: Discussionmentioning

confidence: 99%

Thalamopeduncular Tumors in Pediatric Age: Advanced Preoperative Imaging to Define Safe Surgical Planning: A Multicentric Experience

D’Amico,

Furlanis,

Baro

et al. 2023

JCM

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Background: Thalamopeduncular tumors are challenging lesions arising at the junction between the thalamus and the cerebral peduncle. They represent 1–5% of pediatric brain tumors, are mainly pilocytic astrocytoma and occur within the first two decades of life. To date, the optimal treatment remains unclear. Methods: We retrospectively reviewed pediatric patients who underwent surgery for thalamopeduncular tumors in the Academic Pediatric Neurosurgery Unit of Padova and Verona from 2005 to 2022. We collected information on age, sex, symptoms, preoperative and postoperative neuroradiological studies, histological specimens, surgical approaches, and follow-up. Results: We identified eight patients with a mean age of 9 years. All lesions were pilocytic astrocytoma. The main symptoms were spastic hemiparesis, cranial nerve palsy, headache, and ataxia. The corticospinal tract was studied in all patients using diffusion-tensor imaging brain MRI and in two patients using navigated transcranial magnetic stimulation. The transsylvian approach was the most frequently used. A gross total resection was achieved in two patients, a subtotal resection in five and a partial resection in one. In three patients, a second treatment was performed due to the regrowth of the tumor, performing an additional surgery in two cases and a second-look surgery followed by adjuvant therapy in one. After the surgery, four patients maintained stability in their postoperative neurological exam, two patients improved, and two worsened but in one of them, an improvement during recovery occurred. At the last follow-up available, three patients were disease-free, four had a stable tumor residual, and only one patient died from the progression of the disease. Conclusions: Advanced preoperative tools allow one to define a safe surgical strategy. Due to the indolent behavior of thalamopeduncular tumors, surgery should be encouraged.

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“…They can be found along the neuraxis, including the optic chiasm, hypothalamus, cerebral hemisphere, brainstem and cerebellum. Among them, cerebellar Pas is the most frequently encountered localization [12] but peduncular involvement remains rare [13].…”

Section: Discussionmentioning

confidence: 99%

“…Recent advances in neuro-imaging and micro neurosurgery allow near total resection (NTR) or even GTR of such lesions with favorable outcomes [16,17]; however, the preservation of neurological functions remains a primary goal of the treatment. Residual tumors can be safely managed with adjunct treatments, such as targeted chemotherapy based on tumor's molecular genetics and radiotherapy [13].…”

Section: Discussionmentioning

confidence: 99%

Endoscope-Assisted Extreme Lateral Supracerebellar Infratentorial Approach for Resection of Superior Cerebellar Peduncle Pilocytic Astrocytoma: Technical Note

et al. 2022

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(1) Background: Superior cerebellar peduncle (SCP) lesions are sparsely reported in the literature. The surgical approaches to the cerebello-mesencephalic region remain challenging. In this article, we present the extreme lateral supracerebellar infratentorial (ELSI) approach to treat a large hemorrhagic pilocytic astrocytoma of the SCP. (2) Methods: An 11-year-old boy, known for neurofibromatosis Type I, presented to the emergency department of our institution with symptoms and signs of intracranial hypertension. The cerebral magnetic resonance imaging (MRI) revealed a large hemorrhagic lesion centered on the SCP provoking obstructive hydrocephalus. Following an emergency endoscopic third ventriculocisternostomy (ETV), he underwent a tumor resection via an endoscope-assisted ELSI approach. (3) Results: ELSI approach allows for a wide exposure with direct access to lesions of the SCP. The post-operative course was uneventful, and the patient was discharged home on post-operative day 5. Post-operative MRI revealed a near total resection with a small residual tumor within the mesencephalon. (4) Conclusion: ELSI approach offers an excellent exposure with the surgical angles necessary for median and paramedian lesions. The park-bench position with appropriate head flexion and rotation offers a gravity-assisted relaxation of the tentorial and petrosal cerebellar surfaces. The endoscope can be an adjunct to illuminate the blind areas of the surgical corridor for an improved tumor resection without significant cerebellar retraction.

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Survival and functional outcomes in paediatric thalamic and thalamopeduncular low grade gliomas

Cited by 7 publications

References 44 publications

Surgical Treatment of Paediatric Thalamic Gliomas—Single-Centre Experience

Surgical Treatment of Paediatric Thalamic Gliomas—Single-Centre Experience

Thalamopeduncular Tumors in Pediatric Age: Advanced Preoperative Imaging to Define Safe Surgical Planning: A Multicentric Experience

Endoscope-Assisted Extreme Lateral Supracerebellar Infratentorial Approach for Resection of Superior Cerebellar Peduncle Pilocytic Astrocytoma: Technical Note

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