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Thalamic tumors in children. Long-term follow-up and treatment guidelines
Insights
This study on pediatric thalamic tumors found that malignant types were fatal, while benign tumors had a better prognosis. Open biopsy and radiation are recommended for thalamic tumors in children.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Neuroradiology
Background:
- Thalamic tumors are rare and challenging pediatric neoplasms.
- Diagnosis and treatment have evolved with advancements like computed tomography (CT).
- Understanding outcomes is crucial for guiding therapeutic strategies.
Purpose of the Study:
- To review the clinical course and outcomes of children with thalamic tumors.
- To evaluate the impact of diagnostic era (pre-CT vs. CT) on patient management.
- To provide evidence-based recommendations for the surgical and oncological management of pediatric thalamic tumors.
Main Methods:
- Retrospective review of 60 pediatric patients with thalamic tumors treated between 1951 and 1983.
- Analysis of diagnostic methods (neuroradiology, histology), surgical interventions (biopsy, resection), and adjuvant therapies (radiation, shunting).
- Comparison of outcomes based on tumor histology (benign vs. malignant) and diagnostic era.
Main Results:
- Malignant thalamic tumors had a uniformly fatal outcome (20 patients died, mean survival 1.1 years).
- Benign thalamic tumors showed variable outcomes, with 11 of 19 patients dying (mean survival 5.3 years) and 8 surviving (mean follow-up 7.2 years).
- Cerebrospinal fluid shunting was required in 36 patients; open biopsy was performed in 20, and partial resection in 21.
Conclusions:
- Open biopsy for suspected thalamic tumors is recommended, followed by resection if feasible and safe.
- Radiation therapy should be considered for select cases, particularly those with malignant histology.
- Early diagnosis and appropriate surgical intervention are critical for improving outcomes in pediatric thalamic tumors.
Abstract:
The authors review the cases of 60 children (aged 5 months to 18 years) with thalamic tumors who were seen at The Hospital for Sick Children between 1951 and 1983. The diagnosis of thalamic tumor was based on neuroradiological studies; 33 children were first seen in the pre-computerized tomography (CT) era and 27 since the advent of CT scanning. Histological diagnosis was obtained in 37 patients at the time of operation. A further four tumors were verified histologically at autopsy. Thirty-six patients required cerebrospinal fluid shunt placement. Sixteen patients had no surgery on their tumor, three underwent needle biopsy, 20 underwent open biopsy, and 21 had partial resection. Forty-four patients were irradiated. All 20 patients with malignant tumors died, with a mean survival time of 1.1 years. Of 19 patients with benign tumors, 11 died, with a mean survival time of 5.3 years, and eight are still alive after a mean period of 7.2 years since diagnosis. Based on this series, the authors recommend open biopsy of thalamic tumors (and resection if deemed safe), followed by radiation in selected cases.