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

Acta Neurochir (Wien). 2022 Jun;164(6):1459-1472. doi: 10.1007/s00701-021-05106-5. Epub 2022 Jan 19.


Background: Childhood thalamopeduncular gliomas arise at the interface of the thalamus and cerebral peduncle. The optimal treatment is total resection but not at the cost of neurological function. We present long-term clinical and oncological outcomes of maximal safe resection.

Methods: Retrospective review of prospectively collected data: demography, symptomatology, imaging, extent of resection, surgical complications, histology, functional and oncological outcome.

Results: During 16-year period (2005-2020), 21 patients were treated at our institution. These were 13 girls and 8 boys (mean age 7.6 years). Presentation included progressive hemiparesis in 9 patients, raised intracranial pressure in 9 patients and cerebellar symptomatology in 3 patients. The tumour was confined to the thalamus in 6 cases. Extent of resection was judged on postoperative imaging as total (6), near-total (6) and less extensive (9). Surgical complications included progression of baseline neurological status in 6 patients, and 5 of these gradually improved to preoperative status. All tumours were classified as low-grade gliomas. Disease progression was observed in 9 patients (median progression-free survival 7.3 years). At last follow-up (median 6.1 years), all patients were alive, median Lansky score of 90. Seven patients were without evidence of disease, 6 had stable disease, 7 stable following progression and 1 had progressive disease managed expectantly.

Conclusion: Paediatric patients with low-grade thalamopeduncular gliomas have excellent long-term functional and oncological outcomes when gross total resection is not achievable. Surgery should aim at total resection; however, neurological function should not be endangered due to excellent chance for long-term survival.

Keywords: Childhood glioma; Extent of resection; Low-grade astrocytoma; Survival; Thalamus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Neoplasms* / complications
  • Brain Neoplasms* / diagnostic imaging
  • Brain Neoplasms* / surgery
  • Child
  • Female
  • Glioma* / complications
  • Glioma* / diagnostic imaging
  • Glioma* / surgery
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Neurosurgical Procedures / methods
  • Retrospective Studies
  • Thalamus / diagnostic imaging
  • Thalamus / pathology
  • Thalamus / surgery
  • Treatment Outcome