Endoscopic management of a low-grade thalamic glioma: a safe alternative to open microsurgery?
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Despite considerable advances in preoperative and intraoperative imaging and neuronavigation, resection of thalamic gliomas remains challenging. Although both endoscopic biopsy and third ventriculostomy (ETV) for the treatment of secondary hydrocephalus are commonly performed, endoscopic resection of thalamic gliomas has been very sparsely described.
We report and illustrate the surgical procedure and patient’s outcome after full endoscopic resection of a thalamic glioma and to discuss this approach as an alternative to open microsurgery.
In 2016, a 56-year-old woman presented with disorientation, dysphasia and right facial hypaesthesia in our department. Cranial magnetic resonance imaging revealed a left thalamic lesion and subsequent hydrocephalus. Initially, hydrocephalus was treated by ETV but forceps biopsy was not diagnostic. However, metabolism in 18F-fluoroethyl-L-tyrosine positron emission tomography indicated glioma. Subsequently, endoscopic and neuronavigation-guided tumour resection was performed using a <1 cm2, trans-sulcal approach through the left posterior horn of the lateral ventricle. While visibility was poor using the intraoperative microscope, neuroendoscopy provided excellent visualisation and allowed safe tumour debulking. Neither haemorrhage from the tumour or collapse of the cavity compromised endoscopic resection.
In accordance with one previously published case of endoscopic resection of a thalamic glioma, no surgery-related complications were observed. Although this remains to be determined in larger series, endoscopic resection of these lesions might be a safe and feasible alternative to biopsy or open surgery. Future studies should also aim to identify patients specifically eligible for these approaches.
KeywordsEndoscopic third ventriculostomy Glioma Neuroendoscopy Resection Thalamic
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
Data collection, scientific use and publication were approved by the local ethics committee (Münster 2007-420-f-S).
Data collection, scientific use and publication were allowed by the patient, as it is standard in our institution.
Selected sequences of the endoscopic third ventriculostomy and biopsy of the tumour. (MP4 54661 kb)
Selected sequences of the endoscopic tumour resection. At the end, the spectator gets a short view at the posterior horn of the lateral ventricle. (MP4 57807 kb)
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