Pediatric thalamic incidentalomas: an international retrospective multicenter study

Area of Science:

• Pediatric neurosurgery
• Neuroradiology
• Pediatric oncology

Background:

• Modern neuroimaging frequently detects incidental thalamic lesions in children.
• Thalamic lesions present unique challenges due to their deep location and proximity to critical brain structures.
• The natural history of these incidental thalamic lesions is not well understood.

Purpose of the Study:

• To investigate the characteristics and outcomes of incidentally discovered thalamic lesions in pediatric patients.
• To analyze treatment strategies and long-term follow-up for these lesions.
• To contribute to understanding the natural course of incidental thalamic lesions in children.

Main Methods:

• Retrospective international multicenter study across 8 pediatric tertiary care centers.
• Inclusion criteria: patients under 20 years with incidental thalamic lesions suspected to be tumors.
• Analysis of treatment strategies, imaging, pathology, and outcomes for operated and non-operated cases.

Main Results:

• 58 children (mean age 10.8 years) were included; common indications for imaging were nonspecific reasons and headaches.
• 19% underwent early surgery; 47 were followed, with 10 undergoing delayed surgery due to progression.
• Most frequent pathologies included pilocytic astrocytoma and WHO grade II astrocytoma; 3 were high-grade gliomas.

Conclusions:

• Pediatric incidental thalamic lesions encompass a spectrum of low- and high-grade tumors.
• Long-term radiological surveillance is essential for children not immediately operated on, due to potential tumor progression.