Thalamic glioma

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.

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.{{Cite journal |last1=Niu |first1=Xiaodong |last2=Wang |first2=Tianwei |last3=Yang |first3=Yuan |last4=Gan |first4=Youjun |last5=Li |first5=Jiaoming |last6=Liu |first6=Yanhui |last7=Mao |first7=Qing |date=2018-02-02 |title=Prognostic Factors for the Survival Outcome of Bilateral Thalamic Glioma: An Integrated Survival Analysis |url=https://doi.org/10.1016/j.wneu.2017.10.132 |journal=World Neurosurgery |volume=110 |pages=e222–e230 |doi=10.1016/j.wneu.2017.10.132 |pmid=29102752 |issn=1878-8750|doi-access=free }}

Unless a thalamic glioma shows aggressive behavior, they are often treated with a "watch and wait" approach until signs of growth occur.{{Cite journal |last1=Ryall |first1=Scott |last2=Tabori |first2=Uri |last3=Hawkins |first3=Cynthia |date=2020-03-12 |title=Pediatric low-grade glioma in the era of molecular diagnostics |journal=Acta Neuropathologica Communications |language=en |volume=8 |issue=1 |page=30 |doi=10.1186/s40478-020-00902-z |doi-access=free |issn=2051-5960 |pmc=7066826 |pmid=32164789}} Thalamic gliomas can be treated with radiotherapy, chemotherapy, and/or resection.{{Cite journal |last1=Dixit |first1=Karan |last2=Schulte |first2=Jessica |last3=Kumthekar |first3=Priya |last4=Liu |first4=Benjamin |last5=Jovanovic |first5=Borko |last6=Helenowski |first6=Irene |last7=Raizer |first7=Jeffrey |date=2016-04-05 |title=Clinical Course of Adult Patients with Thalamic Gliomas (P6.297) |url=https://www.neurology.org/doi/10.1212/WNL.86.16_supplement.P6.297 |journal=Neurology |language=en |volume=86 |issue=16_supplement |doi=10.1212/WNL.86.16_supplement.P6.297 |issn=0028-3878|url-access=subscription }}

Thalamic gliomas are among the most difficult challenges a neurosurgeon faces today. Historically, thalamic gliomas were considered inoperable.{{Cite web |title=Thalamic Glioma Overview |url=https://www.moffitt.org/cancers/brain-cancer/diagnosis/types/thalamic-glioma/ |access-date=2024-04-30 |website=Moffitt Cancer Center |language=en}} Advances in neurosurgical technology have opened up the thalamic area to resection, but conservative approaches remain popular.{{Cite journal |last1=Serra |first1=Carlo |last2=Türe |first2=Hatice |last3=Yaltırık |first3=Cumhur Kaan |last4=Harput |first4=Mehmet Volkan |last5=Türe |first5=Uğur |date=2020-10-02 |title=Microneurosurgical removal of thalamic lesions: surgical results and considerations from a large, single-surgeon consecutive series |url=https://thejns.org/view/journals/j-neurosurg/135/2/article-p458.xml |journal=Journal of Neurosurgery |language=EN |volume=135 |issue=2 |pages=458–468 |doi=10.3171/2020.6.JNS20524 |pmid=33007756 |issn=1933-0693}} Microsurgical approaches are well suited for thalamic gliomas.{{Cite journal |last1=Wu |first1=Biwu |last2=Tang |first2=Chao |last3=Wang |first3=Yang |last4=Li |first4=Zhiqi |last5=Hu |first5=Shukun |last6=Hua |first6=Wei |last7=Li |first7=Wengang |last8=Huang |first8=Shan |last9=Ma |first9=Junfeng |last10=Zhang |first10=Yi |date=March 2018 |title=High-grade thalamic gliomas: Microsurgical treatment and prognosis analysis |url=https://doi.org/10.1016/j.jocn.2017.12.008 |journal=Journal of Clinical Neuroscience |volume=49 |pages=56–61 |doi=10.1016/j.jocn.2017.12.008 |pmid=29248381 |issn=0967-5868|url-access=subscription }}

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%.{{Cite journal |last1=Palmisciano |first1=Paolo |last2=El Ahmadieh |first2=Tarek Y. |last3=Haider |first3=Ali S. |last4=Bin Alamer |first4=Othman |last5=Robertson |first5=Faith C. |last6=Plitt |first6=Aaron R. |last7=Aoun |first7=Salah G. |last8=Yu |first8=Kenny |last9=Cohen-Gadol |first9=Aaron |last10=Moss |first10=Nelson S. |last11=Patel |first11=Toral R. |last12=Sawaya |first12=Raymond |date=2021-11-19 |title=Thalamic gliomas in adults: a systematic review of clinical characteristics, treatment strategies, and survival outcomes |url=https://link.springer.com/10.1007/s11060-021-03898-1 |journal=Journal of Neuro-Oncology |language=en |volume=155 |issue=3 |pages=215–224 |doi=10.1007/s11060-021-03898-1 |pmid=34797525 |issn=0167-594X|url-access=subscription }} 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%.{{Cite journal |last1=Gupta |first1=Avneesh |last2=Shaller |first2=Nathan |last3=McFadden |first3=Kathryn A. |date=2017-10-01 |title=Pediatric Thalamic Gliomas: An Updated Review |url=https://doi.org/10.5858/arpa.2017-0249-RA |journal=Archives of Pathology & Laboratory Medicine |volume=141 |issue=10 |pages=1316–1323 |doi=10.5858/arpa.2017-0249-ra |pmid=28968159 |issn=0003-9985|doi-access=free }} 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{{Cite journal |last1=Esquenazi |first1=Yoshua |last2=Moussazadeh |first2=Nelson |last3=Link |first3=Thomas W |last4=Hovinga |first4=Koos E |last5=Reiner |first5=Anne S |last6=DiStefano |first6=Natalie M |last7=Brennan |first7=Cameron |last8=Gutin |first8=Philip |last9=Tabar |first9=Viviane |date=July 2018 |title=Thalamic Glioblastoma: Clinical Presentation, Management Strategies, and Outcomes |url=https://journals.lww.com/00006123-201807000-00012 |journal=Neurosurgery |language=en |volume=83 |issue=1 |pages=76–85 |doi=10.1093/neuros/nyx349 |issn=0148-396X |pmc=6939410 |pmid=28973417}} 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.{{Cite journal |last1=Grimaldi |first1=Stéphan |last2=Harlay |first2=Vincent |last3=Appay |first3=Romain |last4=Bequet |first4=Céline |last5=Petrirena |first5=Grégorio |last6=Campello |first6=Chantal |last7=Barrié |first7=Maryline |last8=Autran |first8=Didier |last9=Boissonneau |first9=Sébastien |last10=Graillon |first10=Thomas |last11=Figarella-Branger |first11=Dominique |last12=Nanni |first12=Isabelle |last13=Chinot |first13=Olivier |last14=Tabouret |first14=Emeline |date=2022-02-01 |title=Adult H3K27M mutated thalamic glioma patients display a better prognosis than unmutated patients |url=https://doi.org/10.1007/s11060-022-03943-7 |journal=Journal of Neuro-Oncology |language=en |volume=156 |issue=3 |pages=615–623 |doi=10.1007/s11060-022-03943-7 |issn=1573-7373|url-access=subscription }}

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

• Tammi Terrell (1945–1970), Motown singer that died from an "acorn size" tumor in her thalamus{{Cite book |last=Cosgrove |first=Stuart |title=Detroit 67: The Year That Changed Soul |date=2016-10-02 |publisher=Polygon |isbn=978-0-85790-334-1 |edition=Revised |location=Edinburgh}}

• [https://thalamicgliomaregistry.org/ Thalamic Glioma Registry] at Weill Cornell
• [https://www.dana-farber.org/cancer-care/types/childhood-thalamic-hypothalamic-astrocytoma Childhood Thalamic and Hypothalamic Astrocytoma] at Dana Farber
• [https://www.neurosurgicalatlas.com/volumes/brain-tumors/supratentorial-and-posterior-fossa-tumors/resection-of-thalamic-tumors Thalamic tumors] at Neurosurgical Atlas

{{Nervous system tumors}}

Category:Thalamus

Category:Nervous system neoplasia