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Thalamopeduncular Tumors in Pediatric Age: Advanced Preoperative Imaging to Define Safe Surgical Planning: A
Alberto D'Amico1, Giulia Melinda Furlanis1, Valentina Baro1
1Academic Neurosurgery, Department of Neurosciences, University of Padova, 35122 Padova, Italy.
Insights
Surgery for pediatric thalamopeduncular tumors, primarily pilocytic astrocytoma, is encouraged. Advanced imaging aids surgical strategy, with most patients achieving stable disease or remission.
Area of Science:
- Pediatric Neurosurgery
- Neuro-oncology
- Brain Tumor Research
Background:
- Thalamopeduncular tumors are rare pediatric brain tumors (1-5%) primarily affecting individuals under 20.
- Pilocytic astrocytoma is the predominant histology.
- Optimal treatment strategies for these challenging lesions remain undefined.
Purpose of the Study:
- To retrospectively analyze surgical outcomes for pediatric thalamopeduncular tumors.
- To evaluate the efficacy of different surgical approaches and adjuvant therapies.
- To assess the long-term disease control and neurological status of affected children.
Main Methods:
- Retrospective review of pediatric patients (2005-2022) with thalamopeduncular tumors.
- Collection of clinical, radiological, histological, surgical, and follow-up data.
- Utilized diffusion-tensor imaging (DTI) and navigated transcranial magnetic stimulation (nTMS) for corticospinal tract assessment.
Main Results:
- Eight pediatric patients (mean age 9 years) with pilocytic astrocytoma were identified.
- The transsylvian surgical approach was most common; gross total resection was achieved in 2/8 patients.
- Post-surgery, 4/8 patients showed stable neurological status, 2/8 improved, and 2/8 experienced worsening with one later improvement. Three patients were disease-free at last follow-up.
Conclusions:
- Advanced preoperative imaging (DTI, nTMS) is crucial for defining safe surgical strategies.
- Surgery should be considered for thalamopeduncular tumors due to their generally indolent nature.
- Multimodal treatment including repeat surgery and adjuvant therapy may be necessary for tumor recurrence.
Abstract:
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.
