Skip to main content
SpringerLink
Log in

Pediatric thalamic tumors in the MRI era: a Canadian perspective

Child's Nervous System volume 32, pages 269–280 (2016)Cite this article

Abstract

Background

Thalamic gliomas are rare. The natural history is unpredictable, and the optimal management of these tumors in children is poorly defined. The aim was to identify outcomes, prognostic factors, and response to various modalities of treatment in a relatively large population of pediatric thalamic tumors from many centers within a fairly homogeneous health care system.

Methods

We performed a Canadian multicenter retrospective review of pediatric thalamic tumors presenting during the MRI era (1989–2012). Radiology and pathology were reviewed by central independent reviewers. Paraffin shavings for RNA extraction were taken and tested for fusion events involving KIAA1549:BRAF. Tumors were classified as unilateral or bithalamic based on their origin on imaging. Univariate and multivariate analyses on factors influencing survival were performed.

Results

Seventy-two thalamic tumors were identified from 11 institutions. Females represented 53 % of the study population, and the mean age at presentation was 8.9 years. Sixty-two tumors were unilateral and 10 bithalamic. Unilateral tumors had a greater propensity to grow inferiorly towards the brainstem. These tumors were predominantly low grade in comparison to bithalamic tumors which were high-grade astrocytomas. The 5-year overall survival was 61 ± 13 % for unithalamic tumors compared to 37 ± 32 % for bithalamic tumors (p = 0.097). Multivariate analysis indicated tumor grade as the only significant prognostic factor for unithalamic tumors. Six unilateral tumors, all low grade, were BRAF fusion positive.

Conclusion

Unilateral and bilateral thalamic tumors behave differently. Surgical resection is an appropriate treatment option in unilateral tumors, most of which are low grade, but outcome is not related to extent of resection (EOR). Bilateral thalamic tumors have a poorer prognosis, but the occasional patient does remarkably well. The efficacy of chemotherapy and radiotherapy has not been clearly demonstrated. Novel therapeutic approaches are required to improve the prognosis for malignant unilateral thalamic tumors and bilateral thalamic tumors.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Colosimo C, di Lella GM, Tartaglione T, Riccardi R (2002) Neuroimaging of thalamic tumors in children. Childs Nerv Syst 18:426–439

    Article  PubMed  Google Scholar 

  2. Cuccia V, Monges J (1997) Thalamic tumors in children. Childs Nerv Syst 13:514–520, discussion 521

    Article  CAS  PubMed  Google Scholar 

  3. Di Rocco C, Iannelli A (2002) Bilateral thalamic tumors in children. Childs Nerv Syst 18:440–444

    Article  PubMed  Google Scholar 

  4. Fernandez C, Maues de Paula A, Colin C, Quilichini B, Bouvier-Labit C, Girard N, Scavarda D, Lena G, Figarella-Branger D (2006) Thalamic gliomas in children: an extensive clinical, neuroradiological and pathological study of 14 cases. Childs Nerv Syst 22:1603–1610

    Article  PubMed  Google Scholar 

  5. Puget S, Crimmins DW, Garnett MR, Grill J, Oliveira R, Boddaert N, Wray A, Lelouch-Tubiana A, Roujeau T, Di Rocco F, Zerah M, Sainte-Rose C (2007) Thalamic tumors in children: a reappraisal. J Neurosurg 106:354–362

    PubMed  Google Scholar 

  6. Baroncini M, Vinchon M, Mineo JF, Pichon F, Francke JP, Dhellemmes P (2007) Surgical resection of thalamic tumors in children: approaches and clinical results. Childs Nerv Syst 23:753–760

    Article  PubMed  Google Scholar 

  7. Kramm CM, Butenhoff S, Rausche U, Warmuth-Metz M, Kortmann RD, Pietsch T, Gnekow A, Jorch N, Janssen G, Berthold F, Wolff JE (2011) Thalamic high-grade gliomas in children: a distinct clinical subset? Neuro Oncol 13:680–689

    Article  PubMed Central  PubMed  Google Scholar 

  8. Bilginer B, Narin F, Isikay I, Oguz KK, Soylemezoglu F, Akalan N (2014) Thalamic tumors in children. Childs Nerv Syst

  9. Menon G, Nair S, Sudhir J, Rao BR, Krishnakumar K (2010) Bilateral thalamic lesions. Br J Neurosurg 24:566–571

    Article  CAS  PubMed  Google Scholar 

  10. Martinez-Lage JF, Perez-Espejo MA, Esteban JA, Poza M (2002) Thalamic tumors: clinical presentation. Childs Nerv Syst 18:405–411

    PubMed  Google Scholar 

  11. Moshel YA, Link MJ, Kelly PJ (2007) Stereotactic volumetric resection of thalamic pilocytic astrocytomas. Neurosurgery 61:66–75, discussion 75

    Article  PubMed  Google Scholar 

  12. Sai Kiran NA, Thakar S, Dadlani R, Mohan D, Furtado SV, Ghosal N, Aryan S, Hegde AS (2013) Surgical management of thalamic gliomas: case selection, technical considerations, and review of literature. Neurosurg Rev 36:383–393

    Article  PubMed  Google Scholar 

  13. Eisenstat DD, Pollack IF, Demers A, Sapp MV, Lambert P, Weisfeld-Adams JD, Burger PC, Gilles F, Davis RL, Packer R, Boyett JM, Finlay JL (2015) Impact of tumor location and pathological discordance on survival of children with midline high-grade gliomas treated on Children’s Cancer Group high-grade glioma study CCG-945. J Neurooncol 121:573–581

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Fouladi M, Hunt DL, Pollack IF, Dueckers G, Burger PC, Becker LE, Yates AJ, Gilles FH, Davis RL, Boyett JM, Finlay JL (2003) Outcome of children with centrally reviewed low-grade gliomas treated with chemotherapy with or without radiotherapy on Children’s Cancer Group high-grade glioma study CCG-945. Cancer 98:1243–1252

    Article  PubMed  Google Scholar 

  15. Gilles FH, Tavare CJ, Becker LE, Burger PC, Yates AJ, Pollack IF, Finlay JL (2008) Pathologist interobserver variability of histologic features in childhood brain tumors: results from the CCG-945 study. Pediatr Dev Pathol 11:108–117

    Article  PubMed  Google Scholar 

  16. Pollack IF, Boyett JM, Yates AJ, Burger PC, Gilles FH, Davis RL, Finlay JL (2003) The influence of central review on outcome associations in childhood malignant gliomas: results from the CCG-945 experience. Neuro Oncol 5:197–207

    Article  PubMed Central  PubMed  Google Scholar 

  17. Albright AL (2004) Feasibility and advisability of resections of thalamic tumors in pediatric patients. J Neurosurg 100:468–472

    PubMed  Google Scholar 

  18. de Fatima Vasco Aragao M, Law M, Batista de Almeida D, Fatterpekar G, Delman B, Bader AS, Pelaez M, Fowkes M, Vieira de Mello R, Moraes Valenca M (2014) Comparison of perfusion, diffusion, and MR spectroscopy between low-grade enhancing pilocytic astrocytomas and high-grade astrocytomas. AJNR Am J Neuroradiol 35:1495–1502

    Article  PubMed  Google Scholar 

  19. Davies NP, Wilson M, Harris LM, Natarajan K, Lateef S, Macpherson L, Sgouros S, Grundy RG, Arvanitis TN, Peet AC (2008) Identification and characterisation of childhood cerebellar tumours by in vivo proton MRS. NMR Biomed 21:908–918

    Article  CAS  PubMed  Google Scholar 

  20. Mabray MC, Barajas RF Jr, Cha S (2015) Modern brain tumor imaging. Brain Tumor Res Treat 3:8–23

    Article  PubMed Central  PubMed  Google Scholar 

  21. Messing-Junger AM, Floeth FW, Pauleit D, Reifenberger G, Willing R, Gartner J, Coenen HH, Langen KJ (2002) Multimodal target point assessment for stereotactic biopsy in children with diffuse bithalamic astrocytomas. Childs Nerv Syst 18:445–449

    Article  CAS  PubMed  Google Scholar 

  22. Souweidane MM, Hoffman HJ (1996) Current treatment of thalamic gliomas in children. J Neurooncol 28:157–166

    Article  CAS  PubMed  Google Scholar 

  23. Ozek MM, Ture U (2002) Surgical approach to thalamic tumors. Childs Nerv Syst 18:450–456

    Article  PubMed  Google Scholar 

  24. Steiger HJ, Gotz C, Schmid-Elsaesser R, Stummer W (2000) Thalamic astrocytomas: surgical anatomy and results of a pilot series using maximum microsurgical removal. Acta Neurochir (Wien) 142:1327–1336, discussion 1336–1327

    Article  CAS  Google Scholar 

  25. Broadway SJ, Ogg RJ, Scoggins MA, Sanford R, Patay Z, Boop FA (2011) Surgical management of tumors producing the thalamopeduncular syndrome of childhood. J Neurosurg Pediatr 7:589–595

    Article  PubMed Central  PubMed  Google Scholar 

  26. Law N, Bouffet E, Laughlin S, Laperriere N, Briere ME, Strother D, McConnell D, Hukin J, Fryer C, Rockel C, Dickson J, Mabbott D (2011) Cerebello-thalamo-cerebral connections in pediatric brain tumor patients: impact on working memory. Neuroimage 56:2238–2248

    Article  PubMed  Google Scholar 

  27. Moshel YA, Elliott RE, Monoky DJ, Wisoff JH (2009) Role of diffusion tensor imaging in resection of thalamic juvenile pilocytic astrocytoma. J Neurosurg Pediatr 4:495–505

    Article  PubMed  Google Scholar 

  28. Reardon DA, Gajjar A, Sanford RA, Heideman RL, Walter AW, Thompson SJ, Merchant TE, Li H, Jenkins JJ, Langston J, Boyett JM, Kun LE (1998) Bithalamic involvement predicts poor outcome among children with thalamic glial tumors. Pediatr Neurosurg 29:29–35

    Article  CAS  PubMed  Google Scholar 

  29. Khanna PC, Iyer RS, Chaturvedi A, Thapa MM, Ishak GE, Shaw DW (2011) Imaging bithalamic pathology in the pediatric brain: demystifying a diagnostic conundrum. AJR Am J Roentgenol 197:1449–1459

    Article  PubMed  Google Scholar 

  30. Hargrave D, Bartels U, Bouffet E (2006) Diffuse brainstem glioma in children: critical review of clinical trials. Lancet Oncol 7:241–248

    Article  PubMed  Google Scholar 

  31. Jansen MH, Veldhuijzen van Zanten SE, Sanchez Aliaga E, Heymans MW, Warmuth-Metz M, Hargrave D, van der Hoeven EJ, Gidding CE, de Bont ES, Eshghi OS, Reddingius R, Peeters CM, Schouten-van Meeteren AY, Gooskens RH, Granzen B, Paardekooper GM, Janssens GO, Noske DP, Barkhof F, Kramm CM, Vandertop WP, Kaspers GJ, van Vuurden DG (2015) Survival prediction model of children with diffuse intrinsic pontine glioma based on clinical and radiological criteria. Neuro Oncol 17:160–166

    Article  PubMed Central  PubMed  Google Scholar 

  32. Vallero SG, Bertin D, Basso ME, Pittana LS, Mussano A, Fagioli F (2014) Diffuse intrinsic pontine glioma in children and adolescents: a single-center experience. Childs Nerv Syst 30:1061–1066

    Article  PubMed  Google Scholar 

  33. Wang ZJ, Rao L, Bhambhani K, Miller K, Poulik J, Altinok D, Sood S (2015) Diffuse intrinsic pontine glioma biopsy: a single institution experience. Pediatr Blood Cancer 62:163–165

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia & British Columbia Children’s Hospital, 4480 Oak St., Room K3-159, V6H 3V4, Vancouver, BC, Canada

    Paul Steinbok, Chittur Viswanathan Gopalakrishnan & Alexander R. Hengel

  2. Division of Neurosurgery, Royal University Hospital, Saskatoon, SK, Canada

    Aleksander M. Vitali

  3. Department of Radiology, University of British Columbia & British Columbia Children’s Hospital, Vancouver, BC, Canada

    Ken Poskitt

  4. Division of Pathology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Cynthia Hawkins

  5. Division of Pediatric Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    James Drake & Maria Lamberti-Pasculli

  6. Division of Neurosurgery, McMaster Children’s Hospital, Hamilton, ON, Canada

    Olufemi Ajani

  7. Division of Neurosurgery, Alberta Children’s Hospital, Calgary, AB, Canada

    Walter Hader

  8. Division of Neurosurgery, Stollery Children’s Hospital, Edmonton, AB, Canada

    Vivek Mehta

  9. Division of Neurosurgery, IWK Health Centre, Halifax, NS, Canada

    P. Daniel McNeely

  10. Section of Neurosurgery, Winnipeg’s Children’s Hospital, Winnipeg, MB, Canada

    Patrick J. McDonald

  11. Division of Neurosurgery, Children’s Hospital, London Health Sciences Center, London, ON, Canada

    Adrianna Ranger

  12. Division of Neurosurgery, University of Ottawa & Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Michael Vassilyadi

  13. Division of Paediatric Neurosurgery, McGill University Health Centre, Montreal, QC, Canada

    Jeff Atkinson

  14. The Arthur and Sonia Labatt Brain Tumour Research Centre, the Hospital for Sick Children, Toronto, ON, Canada

    Scott Ryall

  15. Division of Hematology, Oncology and Palliative Care, Department of Pediatrics, University of Alberta & Stollery Children’s Hospital, Edmonton, AB, Canada

    David D. Eisenstat

  16. Division of Neurology and Oncology, Department of Pediatrics, University of British Columbia & British Columbia Children’s Hospital, Vancouver, BC, Canada

    Juliette Hukin

Authors
  1. Paul Steinbok
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chittur Viswanathan Gopalakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander R. Hengel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aleksander M. Vitali
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ken Poskitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cynthia Hawkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. James Drake
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Lamberti-Pasculli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Olufemi Ajani
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Walter Hader
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Vivek Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. P. Daniel McNeely
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Patrick J. McDonald
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Adrianna Ranger
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Michael Vassilyadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Jeff Atkinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Scott Ryall
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. David D. Eisenstat
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Juliette Hukin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Steinbok.

Ethics declarations

Funding

Financial support was provided by the following organizations:

  • C17 Research Network in partnership with the Childhood Cancer Canada Foundation and the Coast-to-Coast Against Cancer Foundation.

  • Brain Tumor Foundation of Canada

Conflict of interest

The authors have nothing to disclose.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Steinbok, P., Gopalakrishnan, C.V., Hengel, A.R. et al. Pediatric thalamic tumors in the MRI era: a Canadian perspective. Childs Nerv Syst 32, 269–280 (2016). https://doi.org/10.1007/s00381-015-2968-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-015-2968-z

Keywords

search

Navigation