Tractography guides the approach for resection of thalamopeduncular tumors

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Thalamopeduncular tumors arise at the junction of the inferior thalamus and cerebral peduncle, and present with a common clinical syndrome of progressive spastic hemiparesis.


Formal preoperative magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) were performed. Postoperative MRI was obtained to evaluate the extent of tumor resection. A prospective analysis of clinical outcomes was then conducted by the senior author.


Preoperative tractography is a useful adjunct to surgical planning in tumors that displace motor pathways. Gross total resection of pilocytic astrocytomas usually results in cure, and therefore should be entertained when developing treatment strategies for thalamopeduncular tumors of childhood.

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The authors wish to thank Andrew J. Gienapp, BA (Department of Medical Education, Methodist University Hospital, Memphis, TN and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN) for technical and copyediting, and preparation of the manuscript and figures for publishing.

Author information

Correspondence to Frederick Boop.

Ethics declarations


No funding was received for this research.

Conflict of interest

Dr. Boop declares that he has worked as a consultant for Medtronic. Mr. Foley declares that he has no conflict of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Additional information

Key points

1. These tumors are usually of benign pathology

2. They usually occur in children in the first 2 decades of life

3. The children present with progressive spastic hemiparesis, and if the tumor continues to enlarge, will develop hydrocephalus

4. Following resection, the patient’s hemiparesis is usually worsened immediately, but will improve over time and with therapy

5. There is risk of damage to the optic tract and subsequent homonymous hemianopsia

6. There is risk of damage to the third cranial nerve which could prevent opening of the ipsilateral eye or cause diplopia

Electronic supplementary material

Navigated trans-temporal trans-choroidal microsurgical resection of thalamo-peduncular tumor. (MP4 341,468 kb)

Video 1

Navigated trans-temporal trans-choroidal microsurgical resection of thalamo-peduncular tumor. (MP4 341,468 kb)

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Foley, R., Boop, F. Tractography guides the approach for resection of thalamopeduncular tumors. Acta Neurochir 159, 1597–1601 (2017).

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  • Thalamopeduncular tumor
  • Brain stem tumor
  • Pilocytic astrocytoma
  • Pediatric tumor
  • Tractography
  • Transchoroidal resection