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Thalamic gliomas are very rare, deep-seated, generally high-grade glial neoplasms that form in the thalamus, representing 1–5% of all pediatric brain tumors. Because of their difficult to reach position, they are a unique and difficult challenge for neuro-oncologists and neurosurgeons.

Diagnosis

Thalamic gliomas are most often discovered on magnetic resonance imaging following symptoms, with the most common presenting symptom being motor deficit. While a definitive diagnosis of the neoplasm cannot be made without a biopsy of the tumor, biopsies have historically been avoided due to the extreme sensitivity of the region.

Bithalamic glioma

A notable variant of thalamic gliomas are bithalamic gliomas. Bithalamic gliomas cross the interthalamic adhesion and occupy space in both thalami. These have poorer outcomes than unilateral thalamic gliomas.

Treatment

Unless a thalamic glioma shows aggressive behavior, they are often treated with a "watch and wait" approach until signs of growth occur. Thalamic gliomas can be treated with radiotherapy, chemotherapy, and/or resection.

Resection

Thalamic gliomas are among the most difficult challenges a neurosurgeon faces today. Historically, thalamic gliomas were considered inoperable. Advances in neurosurgical technology have opened up the thalamic area to resection, but conservative approaches remain popular. Microsurgical approaches are well suited for thalamic gliomas.

Prognosis

Thalamic gliomas have a poor prognosis. In adult patients, the overall two-year survival rate is 19.7%, with low grade tumors holding a two-year survival rate of 31.0% and high-grade tumors holding a two-year survival rate of 16.5%. In pedtiatric patients, low-grade astrocytomas held a five-year survival rate of 40% while high-grade astrocyte tumors held a five-year survival rate that varies between 15% and 25%. Strangely, pediatric thalamic oligodendrogliomas appear to have a far worse prognosis than thalamic astrocytomas, with a three-year survival rate of 14% in one series.

Higher Karnovsky performance status and CSF diversion are good prognostic markers in cases that match the criteria for glioblastoma.

While the H3K27m mutation that is the distinct marker of a diffuse midline glioma is generally a very poor prognostic factor, it is unusually associated with slightly higher rates of survival in adult thalalmic glioma patients.

Pathology

Thalamic gliomas are often but not exclusively diffuse midline gliomas; other varieties of glial tumor can develop in this region.

Prominent patients

• Tammi Terrell (1945–1970), Motown singer that died from an "acorn size" tumor in her thalamus

References

1. Jeevan, Dhruve S.; Rutka, James T. (2019), Di Rocco, Concezio; Pang, Dachling; Rutka, James T. (eds.), "Thalamic Gliomas", Textbook of Pediatric Neurosurgery, Cham: Springer International Publishing, pp. 1–17, doi:10.1007/978-3-319-31512-6_84-1, ISBN 978-3-319-31512-6, retrieved 2024-04-30
2. ^ Palmisciano, Paolo; El Ahmadieh, Tarek Y.; Haider, Ali S.; Bin Alamer, Othman; Robertson, Faith C.; Plitt, Aaron R.; Aoun, Salah G.; Yu, Kenny; Cohen-Gadol, Aaron; Moss, Nelson S.; Patel, Toral R.; Sawaya, Raymond (2021-11-19). "Thalamic gliomas in adults: a systematic review of clinical characteristics, treatment strategies, and survival outcomes". Journal of Neuro-Oncology. 155 (3): 215–224. doi:10.1007/s11060-021-03898-1. ISSN 0167-594X. PMID 34797525.
3. Niu, Xiaodong; Wang, Tianwei; Yang, Yuan; Gan, Youjun; Li, Jiaoming; Liu, Yanhui; Mao, Qing (2018-02-02). "Prognostic Factors for the Survival Outcome of Bilateral Thalamic Glioma: An Integrated Survival Analysis". World Neurosurgery. 110: e222 – e230. doi:10.1016/j.wneu.2017.10.132. ISSN 1878-8750. PMID 29102752.
4. Ryall, Scott; Tabori, Uri; Hawkins, Cynthia (2020-03-12). "Pediatric low-grade glioma in the era of molecular diagnostics". Acta Neuropathologica Communications. 8 (1): 30. doi:10.1186/s40478-020-00902-z. ISSN 2051-5960. PMC 7066826. PMID 32164789.
5. Dixit, Karan; Schulte, Jessica; Kumthekar, Priya; Liu, Benjamin; Jovanovic, Borko; Helenowski, Irene; Raizer, Jeffrey (2016-04-05). "Clinical Course of Adult Patients with Thalamic Gliomas (P6.297)". Neurology. 86 (16_supplement). doi:10.1212/WNL.86.16_supplement.P6.297. ISSN 0028-3878.
6. "Thalamic Glioma Overview". Moffitt Cancer Center. Retrieved 2024-04-30.
7. Serra, Carlo; Türe, Hatice; Yaltırık, Cumhur Kaan; Harput, Mehmet Volkan; Türe, Uğur (2020-10-02). "Microneurosurgical removal of thalamic lesions: surgical results and considerations from a large, single-surgeon consecutive series". Journal of Neurosurgery. 135 (2): 458–468. doi:10.3171/2020.6.JNS20524. ISSN 1933-0693. PMID 33007756.
8. Wu, Biwu; Tang, Chao; Wang, Yang; Li, Zhiqi; Hu, Shukun; Hua, Wei; Li, Wengang; Huang, Shan; Ma, Junfeng; Zhang, Yi (March 2018). "High-grade thalamic gliomas: Microsurgical treatment and prognosis analysis". Journal of Clinical Neuroscience. 49: 56–61. doi:10.1016/j.jocn.2017.12.008. ISSN 0967-5868. PMID 29248381.
9. ^ Gupta, Avneesh; Shaller, Nathan; McFadden, Kathryn A. (2017-10-01). "Pediatric Thalamic Gliomas: An Updated Review". Archives of Pathology & Laboratory Medicine. 141 (10): 1316–1323. doi:10.5858/arpa.2017-0249-ra. ISSN 0003-9985. PMID 28968159.
10. Esquenazi, Yoshua; Moussazadeh, Nelson; Link, Thomas W; Hovinga, Koos E; Reiner, Anne S; DiStefano, Natalie M; Brennan, Cameron; Gutin, Philip; Tabar, Viviane (July 2018). "Thalamic Glioblastoma: Clinical Presentation, Management Strategies, and Outcomes". Neurosurgery. 83 (1): 76–85. doi:10.1093/neuros/nyx349. ISSN 0148-396X. PMC 6939410. PMID 28973417.
11. Grimaldi, Stéphan; Harlay, Vincent; Appay, Romain; Bequet, Céline; Petrirena, Grégorio; Campello, Chantal; Barrié, Maryline; Autran, Didier; Boissonneau, Sébastien; Graillon, Thomas; Figarella-Branger, Dominique; Nanni, Isabelle; Chinot, Olivier; Tabouret, Emeline (2022-02-01). "Adult H3K27M mutated thalamic glioma patients display a better prognosis than unmutated patients". Journal of Neuro-Oncology. 156 (3): 615–623. doi:10.1007/s11060-022-03943-7. ISSN 1573-7373.
12. Cosgrove, Stuart (2016-10-02). Detroit 67: The Year That Changed Soul (Revised ed.). Edinburgh: Polygon. ISBN 978-0-85790-334-1.

External links

• Thalamic Glioma Registry at Weill Cornell
• Childhood Thalamic and Hypothalamic Astrocytoma at Dana Farber
• Thalamic tumors at Neurosurgical Atlas

• Thalamus
• Nervous system neoplasia