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Thalamic glioma

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Thalamic glioma
SpecialtyNeuro-oncology, neurosurgery
CausesUnknown
PreventionUnknown
TreatmentWatchful waiting, radiation therapy, chemotherapy, resection
PrognosisTwo year survival rate 19.7% (adults), pediatric five year survival rate 15-25% (high grade astrocytoma) or 40% (low grade astroyctoma)

Thalamic gliomas are very rare, deep-seated, generally high-grade glial neoplasms that form in the thalamus, representing 1–5% of all pediatric brain tumors.[1] Because of their difficult to reach position, they are a unique and difficult challenge for neuro-oncologists and neurosurgeons.

Diagnosis

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Thalamic gliomas are most often discovered on magnetic resonance imaging following symptoms, with the most common presenting symptom being motor deficit.[2] While a definitive diagnosis of the neoplasm cannot be made without a biopsy of the tumor, biopsies have historically been avoided due to the extreme sensitivity of the region.

Bithalamic glioma

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A notable variant of thalamic gliomas are bithalamic gliomas. Bithalamic gliomas cross the interthalamic adhesion and occupy space in both thalami. These have poorer outcomes than unilateral thalamic gliomas.[3]

Treatment

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Unless a thalamic glioma shows aggressive behavior, they are often treated with a "watch and wait" approach until signs of growth occur.[4] Thalamic gliomas can be treated with radiotherapy, chemotherapy, and/or resection.[5]

Resection

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Thalamic gliomas are among the most difficult challenges a neurosurgeon faces today. Historically, thalamic gliomas were considered inoperable.[6] Advances in neurosurgical technology have opened up the thalamic area to resection, but conservative approaches remain popular.[7] Microsurgical approaches are well suited for thalamic gliomas.[8]

Prognosis

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Thalamic gliomas have a poor prognosis. In adult patients, the overall two-year survival rate is 19.7%, with low grade tumors holding a two-year survival rate of 31.0% and high-grade tumors holding a two-year survival rate of 16.5%.[2] In pedtiatric patients, low-grade astrocytomas held a five-year survival rate of 40% while high-grade astrocyte tumors held a five-year survival rate that varies between 15% and 25%.[9] Strangely, pediatric thalamic oligodendrogliomas appear to have a far worse prognosis than thalamic astrocytomas, with a three-year survival rate of 14% in one series.[9]

Higher Karnovsky performance status and CSF diversion[10] are good prognostic markers in cases that match the criteria for glioblastoma.

While the H3K27m mutation that is the distinct marker of a diffuse midline glioma is generally a very poor prognostic factor, it is unusually associated with slightly higher rates of survival in adult thalalmic glioma patients.[11]

Pathology

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Thalamic gliomas are often but not exclusively diffuse midline gliomas; other varieties of glial tumor can develop in this region.[2]

Prominent patients

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References

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  1. ^ Jeevan, Dhruve S.; Rutka, James T. (2019), Di Rocco, Concezio; Pang, Dachling; Rutka, James T. (eds.), "Thalamic Gliomas", Textbook of Pediatric Neurosurgery, Cham: Springer International Publishing, pp. 1–17, doi:10.1007/978-3-319-31512-6_84-1, ISBN 978-3-319-31512-6, retrieved 2024-04-30
  2. ^ a b c Palmisciano, Paolo; El Ahmadieh, Tarek Y.; Haider, Ali S.; Bin Alamer, Othman; Robertson, Faith C.; Plitt, Aaron R.; Aoun, Salah G.; Yu, Kenny; Cohen-Gadol, Aaron; Moss, Nelson S.; Patel, Toral R.; Sawaya, Raymond (2021-11-19). "Thalamic gliomas in adults: a systematic review of clinical characteristics, treatment strategies, and survival outcomes". Journal of Neuro-Oncology. 155 (3): 215–224. doi:10.1007/s11060-021-03898-1. ISSN 0167-594X. PMID 34797525.
  3. ^ Niu, Xiaodong; Wang, Tianwei; Yang, Yuan; Gan, Youjun; Li, Jiaoming; Liu, Yanhui; Mao, Qing (2018-02-02). "Prognostic Factors for the Survival Outcome of Bilateral Thalamic Glioma: An Integrated Survival Analysis". World Neurosurgery. 110: e222–e230. doi:10.1016/j.wneu.2017.10.132. ISSN 1878-8750. PMID 29102752.
  4. ^ Ryall, Scott; Tabori, Uri; Hawkins, Cynthia (2020-03-12). "Pediatric low-grade glioma in the era of molecular diagnostics". Acta Neuropathologica Communications. 8 (1): 30. doi:10.1186/s40478-020-00902-z. ISSN 2051-5960. PMC 7066826. PMID 32164789.
  5. ^ Dixit, Karan; Schulte, Jessica; Kumthekar, Priya; Liu, Benjamin; Jovanovic, Borko; Helenowski, Irene; Raizer, Jeffrey (2016-04-05). "Clinical Course of Adult Patients with Thalamic Gliomas (P6.297)". Neurology. 86 (16_supplement). doi:10.1212/WNL.86.16_supplement.P6.297. ISSN 0028-3878.
  6. ^ "Thalamic Glioma Overview". Moffitt Cancer Center. Retrieved 2024-04-30.
  7. ^ Serra, Carlo; Türe, Hatice; Yaltırık, Cumhur Kaan; Harput, Mehmet Volkan; Türe, Uğur (2020-10-02). "Microneurosurgical removal of thalamic lesions: surgical results and considerations from a large, single-surgeon consecutive series". Journal of Neurosurgery. 135 (2): 458–468. doi:10.3171/2020.6.JNS20524. ISSN 1933-0693. PMID 33007756.
  8. ^ Wu, Biwu; Tang, Chao; Wang, Yang; Li, Zhiqi; Hu, Shukun; Hua, Wei; Li, Wengang; Huang, Shan; Ma, Junfeng; Zhang, Yi (March 2018). "High-grade thalamic gliomas: Microsurgical treatment and prognosis analysis". Journal of Clinical Neuroscience. 49: 56–61. doi:10.1016/j.jocn.2017.12.008. ISSN 0967-5868. PMID 29248381.
  9. ^ a b Gupta, Avneesh; Shaller, Nathan; McFadden, Kathryn A. (2017-10-01). "Pediatric Thalamic Gliomas: An Updated Review". Archives of Pathology & Laboratory Medicine. 141 (10): 1316–1323. doi:10.5858/arpa.2017-0249-ra. ISSN 0003-9985. PMID 28968159.
  10. ^ Esquenazi, Yoshua; Moussazadeh, Nelson; Link, Thomas W; Hovinga, Koos E; Reiner, Anne S; DiStefano, Natalie M; Brennan, Cameron; Gutin, Philip; Tabar, Viviane (July 2018). "Thalamic Glioblastoma: Clinical Presentation, Management Strategies, and Outcomes". Neurosurgery. 83 (1): 76–85. doi:10.1093/neuros/nyx349. ISSN 0148-396X. PMC 6939410. PMID 28973417.
  11. ^ Grimaldi, Stéphan; Harlay, Vincent; Appay, Romain; Bequet, Céline; Petrirena, Grégorio; Campello, Chantal; Barrié, Maryline; Autran, Didier; Boissonneau, Sébastien; Graillon, Thomas; Figarella-Branger, Dominique; Nanni, Isabelle; Chinot, Olivier; Tabouret, Emeline (2022-02-01). "Adult H3K27M mutated thalamic glioma patients display a better prognosis than unmutated patients". Journal of Neuro-Oncology. 156 (3): 615–623. doi:10.1007/s11060-022-03943-7. ISSN 1573-7373.
  12. ^ Cosgrove, Stuart (2016-10-02). Detroit 67: The Year That Changed Soul (Revised ed.). Edinburgh: Polygon. ISBN 978-0-85790-334-1.
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