Current treatment of thalamic gliomas in children

Historically, the outcome of children with thalamic gliomas has been poor. Because of the potential for severe perioperative mortality, conservative approaches toward these lesions have been commonly instituted. However, recent improvements in therapeutic approaches have been numerous. These refinements have most importantly centered on improving the neurosurgical technique of tumor resection by integrating computer-assisted, stereotactic approaches. In so doing, perioperative mortality has dropped from as high as 40% to as low as 0-1%. Gross total resection confirmed with postoperative imaging is becoming an expectation. However, because of anatomical limitations or malignant histology, incomplete resections will undoubtedly occur in an effort to preserve neurological function. At the same time, not all residual disease implies a poor outcome. Indolent, low-grade gliomas of childhood are not limited to the cerebellum or optic/hypothalamic regions, and histologically similar lesions in the region of the thalamus occur with some frequency. In this case scenario, incompletely resected low-grade lesions should be followed sequentially with routine imaging; further therapy, be it surgical or adjuvant, is instituted only if disease progression is documented. Children found to have malignant gliomas of the thalamus should undergo surgical resection in an effort to relieve them of any existing mass effect. Subsequently, adjuvant therapy is utilized depending on the exact histopathology and the child's age. Thus, what evolves from recent data and current surgical techniques is an aggressively directed therapy based upon anatomical considerations and tumor type.