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Current treatment of thalamic gliomas in children

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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 computerassisted, 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.

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  1. 1.

    Jooma R, Hayward RD, Grant N: Intracranial neoplasms during the first year of life: analysis of one hundred consecutive cases. Neurosurgery 14: 31–41, 1984

  2. 2.

    Tadmor R, Harwood-Nash DCF, Savoiardo M, Scotti G, Musgrave M, Fitz CR, Chuang S: Brain tumors in the first two years of life: CT diagnosis. Am J Neuroradial l: 411–417, 1980

  3. 3.

    Tomita T, McLone D: Brain tumors during the first twenty-four months of life. Neurosurgery 17: 913–919, 1985

  4. 4.

    Arseni C: Tumors of the basal ganglia. Arch Neurol Psychiatry 80:18–24, 1958

  5. 5.

    Cheek WR, Taveras JM: Thalamic tumors. J Neurosurg 24: 505–513, 1966

  6. 6.

    McKissock W, Paine KWE: Primary tumors of the thalamus. Brain 81: 41–63, 1958

  7. 7.

    Tovi D, Schisano G, Liijegvist B: Primary tumors of the region of the thalamus. J Neurosurg 18: 730–740, 1961

  8. 8.

    Hoffman HJ, Soloniuk DS, Humphreys RP, Drake JM, Becker LE, DeLima BO, Piatt Jr JH: Management and outcome of low-grade astrocytomas of the midline in children: a retrospective review. Neurosurgery 33: 964–971, 1993

  9. 9.

    Kelly PJ: Stereotactic biopsy and resection of thalamic astrocytomas. Neurosurgery 25: 185–195, 1989

  10. 10.

    Hirose G, Lombroso CT, Eisenberg H: Thalamic tumors in childhood. Arch Neurol 32: 740–744, 1975

  11. 11.

    Bernstein M, Hoffman HJ, Halliday WC, Hendrick EB, Humphreys RP: Thalamic tumors in children: Long term follow-up and treatment guidelines. J Neurosurg 61: 649–656, 1984

  12. 12.

    Smyth GE, Stern K: Tumours of the thalamus: a clinicopathological study. Brain 61: 339–374, 1938

  13. 13.

    Krauss JK, Nobbe F, Wakhloo AK, Mohadjer M, Vach W, Mundinger F: Movement disorders in astrocytomas of the basal ganglia and the thalamus. J Neurol Neurosurg Psychiatry 55: 1162–1167, 1992

  14. 14.

    Ojemann GA, Ward Jr AA: Speech representation in ventrolateral thalamus. Brain 94: 669–680, 1971

  15. 15.

    Piepmeier JM: Observations on the current treatment of low-grade astrocytic tumors of the cerebral hemispheres. J Neurosurg 67: 177–181, 1987

  16. 16.

    Tchang S, Scotti G, Terbrugge K, Melancon D, Belanger C, Milner C, Ethier R: Computerized tomography as a possible aid to histological grading of supratentorial gliomas. J Neurosurg 46: 735–739, 1977

  17. 17.

    McCormack BM, Miller DC, Budzilovich GN, Voorhees GJ, Ransohoff J: Treatment and survival of low-grade astrocytoma in adults — 1977–1988. Neurosurgery 31: 636–642, 1992

  18. 18.

    Silverman C, Marks JE: Prognostic significance of contrast enhancement in low-grade astrocytomas of the adult cerebrum. Radiology 139: 211–213, 1981

  19. 19.

    Kelly PJ, Daumas-Duport C, Kispert DB, Kall BA, Scheithauer BW: Imaging based stereotactic serial biopsies in untreated glial neoplasms. J Neurosurg 66: 865–874, 1987

  20. 20.

    Greenwood Jr J: Radical surgery of tumors of the thalamus, and third ventricle area. Surg Neurol 1: 29–33, 1973

  21. 21.

    Yasargil M: Microneurosurgery Vol. IV A. Thieme, New York, 1994, pp 139–140

  22. 22.

    Palma L, Russo A, Mercuri S: Cystic cerebral astrocytomas in infancy and childhood. Child's Brain 10: 79–91, 1983

  23. 23.

    Opalsky A: Uber lokale Unterschiede im Ban der Ventrikelwande beim Menschen. Z ges Neurol Psychiatr 149: 221–254, 1933

  24. 24.

    Yasue M, Tanaka H, Nakajima M, Kamio M, Nakamura N, Numoto T, Tanaka J; Germ cell tumors of the basal ganglia and thalamus. Pediatr Neurosurg 19: 121–126, 1993

  25. 25.

    Tamaki N, Lin T, Shiratake K, Hosoda K, Kurata H, Matsumoto S, Ito G: Germ cell tumors of the thalamus and the basal ganglia. Childs Nerv Syst 6: 34–37, 1990

  26. 26.

    Zulch KJ: Histological typing of tumours of the central nervous system Vol. No. 21. World Health Organization, Geneva, 1979, p 44

  27. 27.

    27.Matson D: Neurosurgery of Infancy and Childhood. Charles C. Thomas, Springfield, 1969, pp

  28. 28.

    Koos W, Miller M: Intracranial tumors of infants and children. Thieme, Stuttgart, 1971 pp

  29. 29.

    Dohrmann GJ, Farwell JR, Flannery JT: Glioblastoma multiforme in children. J Neurosurg 44: 442–448, 1976

  30. 30.

    Wald SL, Fogelson H, McLaurin RL: Cystic thalamic gliomas. Child's Brain 9: 381–393, 1982

  31. 31.

    Ehni G: Interhemispheric and percollosal (trancollosal) approach to the cingulate gyri, intraventricular shunt tubes, and certain deeply placed brain lesions. Neurosurgery 14: 99–110, 1984

  32. 32.

    Torkildsen A: Should extirpation be attempted in cases of neoplasm in or near the third ventricle of the brain? Experiences with a palliative method. J Neurosurg 5: 249–275, 1948

  33. 33.

    Ward A, Spurling G: The conservative treatment of third ventricle tumors. J Neurosurg 5: 124–130, 1948

  34. 34.

    Apuzzo M, Chandrasoma P, Zelman V, Giannotta S, Weiss M: Computed tomographic guidance stereotaxis in the management of lesions of the third ventricular region. Neurosurgery 15: 502–508, 1984

  35. 35.

    Rekate HL, Ruch T, Nulsen FE, Roessmann U, Spence J: Needle biopsy of tumors in the region of the third ventricle. J Neurosurg 54: 338–341, 1981

  36. 36.

    Shetter AG, Bertuccini TV, Pittman HW: Closed needle biopsy in the diagnosis of intracranial mass lesions. Surg Neurol 8: 341–345, 1977

  37. 37.

    Drake JM, Joy M, Goldenberg A, Kreindler D: Computer and robot assisted resection of thalamic astrocytomas in children. Neurosurgery 29: 27–33, 1991

  38. 38.

    Giorgi C, Riva D: Stereotactically guided transfrontal removal of intraventricular midline tumors in children. Neurosurgical and neuropsychological considerations. J Neurosurg 81: 374–380, 1994

  39. 39.

    McGirr SJ, Kelly PJ, Scheithauer BW: Stereotactic resection of juvenile pilocytic astrocytoma of the thalamus and basal ganglia. Neurosurgery 20: 447–452, 1987

  40. 40.

    Villarejo F, Amaya C, Perez Diaz C, Pascual A, Alvarez Sastre C, Goyenechea F: Radical surgery of thalamic tumors in children. Child's Nervous System 10: 111–114, 1994

  41. 41.

    Packer RJ, Sutton LN, Bilaniuk LT, Radcliffe J, Rosenstock JG, Siegel KR, Bunin GR, Davino PJ, Bruce DA, Schut L: Treatment of chiasmatic/hypothalamic gliomas of child hood with chemotherapy: An update. Ann Neurol 23: 79–85, 1988

  42. 42.

    Petronio J, Edwards MSB, Prados M, Freyberger S, Rabbitt J, Silver P, Levin VA: Management of chiasmal and hypothalamic gliomas of infancy and childhood with chemotherapy. J Neurosurg 74: 701–708, 1991

  43. 43.

    Vertosick FT, Selker RG, Arena VC: Survival of patients with well-differentiated astrocytomas diagnosed in the era of computed tomography. Neurosurgery 28: 496–501, 1991

  44. 44.

    Muller W Afra D, Schroder R: Supratentorial recurrences of gliomas: morphological studies with relation to time intervals in gliomas. Acta Neurochirurgica (Wien) 37: 75–91, 1977

  45. 45.

    Laws ER, Taylor WF, Clifton MB, Okazaki H: Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg 61: 665–673, 1984

  46. 46.

    Gol A: The relatively benign astrocytomas of the cerebrum: a clinical study of 194 verified cases. J Neurosurg 18: 501–506, 1961

  47. 47.

    Westergaard L, Gjerris F, Klinken L: Prognostic parameters in benign astrocytomas. Acta Neurochirurgica 123: 1–7, 1993

  48. 48.

    Gol A: Cerebral astrocytomas in childhood. A clinical study. J Neurosurg 19: 577–582, 1962

  49. 49.

    Mercuri S, Russo A, Palma L: Hemispheric supratentorial astrocytomas in children. J Neurosurg 55: 170–173, 1981

  50. 50.

    Franzini A, Leocata F, Cajola L, Servello D, Allegranza A and Allegranza G.B: Low-grade tumors in basal ganglia and thalamus: natural history and biological reappraisal. Neurosurg 35: 817–821, 1994

  51. 51.

    Hensell V: A special group of astrocytomas: the so-called ‘Bergstrand tumours’. Excerpta Med Int Congr Ser 287, 1973

  52. 52.

    Ringertz N, Nordenstam H: Cerebellar astrocytoma. J Neuropathol Exp Neurol 10: 343–367, 1951

  53. 53.

    Garcia DM, Fulling KH: Juvenile pilocytic astrocytoma of the cerebrum in adults. J Neurosurg 63: 382–386, 1985

  54. 54.

    Palma L, Guidetti B: Cystic pilocytic astrocytomas of the cerebral hemispheres. Surgical experiences with 51 cases and long-term results. J Neurosurg 62: 811–815, 1985

  55. 55.

    Schisano G, Tovi D, Nordenstam H: Spongioblastoma polare of the cerebral hemisphere. J Neurosurg 20: 241–251, 1963

  56. 56.

    Clark GB, Henry JM, McKeever PE: Cerebral pilocytic astrocytoma. Cancer 56: 1128–1133, 1985

  57. 57.

    Thiel G, Lozanova T, Vogel S, Kintzel D, Janisch W Witowski R: Age-related nonrandom chromosomal abnormalities in human low-grade astrocytomas. Hum Genet 91: 547–550, 1993

  58. 58.

    Greenberger J, Cassady J, Levene M: Radiation therapy of thalamic, midbrain and brain stem gliomas. Radiology 122: 463–468, 1976

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Correspondence to Harold J. Hoffman.

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Souweidane, M.M., Hoffman, H.J. Current treatment of thalamic gliomas in children. J Neuro-Oncol 28, 157–166 (1996).

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Key words

  • pediatric glioma
  • thalamus
  • surgery
  • frameless stereotaxis