Skip to main content

Advertisement

SpringerLink
Log in

Evolution of surgical attitudes to paediatric thalamic tumours: the alder hey experience

  • Original Article
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Attitudes to surgery for paediatric thalamic tumours have evolved due to improved preoperative imaging modalities and the advent of intraoperative MRI (iMRI) as well as enhanced understanding of tumour biology. We review the developments in our local practice over the last three decades with particular attention to the impact of iMRI.

Methods

We identified all paediatric patients from a prospectively maintained neuro-oncology database who received surgery for a thalamic tumour (n = 30). All children were treated in a single UK tertiary paediatric neurosurgery centre between January 1991 and June 2020. Twenty patients underwent surgical resection, the remainder (10) undergoing biopsy only. Pre-operative surgical intent (biopsy versus debulking, near-total resection, or complete resection) as well as the use of iMRI were prospectively recorded. Complications recorded in clinical documentation between postoperative days 0 and 30 were retrospectively graded using a modified version of the Clavien Dindo scale. The extent of resection with respect to the pre-determined surgical aim was also recorded. Data on patient survival and disease progression status were obtained retrospectively.

Results

In our series, there were 42 procedures (25 craniotomies, 17 biopsies) performed on 30 patients (17 male, with a median age of 8 at surgery). Of the 25 surgical resections performed, complete resection was achieved in 9 (36%), near-total resection in 10 (40%), and limited debulking in 6 (24%). The predetermined surgical aim was achieved or exceeded in 91.3% of cases. The proportion of craniotomies for which substantial resection was achieved, increased from 37.5 to 94.2% with use of iMRI (p = 0.014). Surgical morbidity was not associated with greater extent of surgical resection. High-grade histology is identified as the only independent significant factor influencing overall survival as calculated by Cox proportional hazards model (p = 0.006).

Conclusion

We note a significant change in the rate and extent of attempted resection of paediatric thalamic tumours that has developed over the last 3 decades. Use of iMRI is associated with a significant increase in substantial tumour resection surgeries. This is not associated with any significant level of surgical morbidity. Improvements in pre- and intra-operative imaging alongside better understanding of tumour biology facilitate patient selection and a surgically more aggressive approach in selected cases whilst maintaining safety and avoiding operative morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gupta A, Shaller N, McFadden KA (2017) Pediatric thalamic gliomas: an updated review. Arch Pathol Lab Med 141:1316–1323

    Article  CAS  Google Scholar 

  2. 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  Google Scholar 

  3. Boesten T, Gerber NU, Kandels D, Azizi AA, Schmidt R, Warmuth-Metz M, Pietsch T, Kortmann R-D, Gnekow A, Grotzer MA (2016) Management of primary thalamic low-grade glioma in pediatric patients: results of the multicenter treatment studies HIT-LGG 1996 and SIOP-LGG 2004. Neuro-Oncology Practice 4:29–39

    Article  Google Scholar 

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

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

    Article  Google Scholar 

  6. 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 

  7. Steinbok P, Gopalakrishnan CV, Hengel AR, Vitali AM, Poskitt K, Hawkins C, Drake J, Lamberti-Pasculli M, Ajani O, Hader W, Mehta V, McNeely PD, McDonald PJ, Ranger A, Vassilyadi M, Atkinson J, Ryall S, Eisenstat DD, Hukin J (2016) Pediatric thalamic tumors in the MRI era: a Canadian perspective. Childs Nerv Syst 32:269–280

    Article  Google Scholar 

  8. Niu X, Wang T, Yang Y, Gan Y, Li J, Liu Y, Mao Q (2018) Prognostic factors for the survival outcome of bilateral thalamic glioma: an integrated survival analysis. World Neurosurg 110:e222–e230

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  11. Beks JW, Bouma GJ, Journée HL (1987) Tumours of the thalamic region. A retrospective study of 27 cases. Acta Neurochir (Wien) 85:125–127

    Article  CAS  Google Scholar 

  12. 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  Google Scholar 

  13. Steiger HJ, Götz C, Schmid-Elsaesser R, Stummer W (2000) Thalamic astrocytomas: surgical anatomy and results of a pilot series using maximum microsurgical removal. Acta Neurochirurgica 142:1327–1336; discussion 1336–1337

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

    Article  Google Scholar 

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

    PubMed  Google Scholar 

  16. Cinalli G, Aguirre DT, Mirone G, Ruggiero C, Cascone D, Quaglietta L, Aliberti F, Santi SD, Buonocore MC, Nastro A, Spennato P (2018) Surgical treatment of thalamic tumors in children. J Neurosurg Pediatr 21:247–257

    Article  Google Scholar 

  17. Kiran NAS, 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  Google Scholar 

  18. 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  Google Scholar 

  19. Bilginer B, Narin F, Işıkay I, Oguz KK, Söylemezoglu F, Akalan N (2014) Thalamic tumors in children. Childs Nerv Syst 30:1493–1498

    Article  Google Scholar 

  20. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW (2016) The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 131:803–820

    Article  Google Scholar 

  21. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  22. Foster MT, Hennigan D, Grayston R, van Baarsen K, Sunderland G, Millward CP, Srinivasan HL, Ferguson D, Totimeh T, Pizer B, Mallucci C (2021) Reporting morbidity associated with pediatric brain tumor surgery: are the available scoring systems sufficient? J Neurosurg Pediatr 1–10

  23. Tejada S, Avula S, Pettorini B, Henningan D, Abernethy L, Mallucci C (2018) The impact of intraoperative magnetic resonance in routine pediatric neurosurgical practice—a 6-year appraisal. Childs Nerv Syst 34:617–626

    Article  Google Scholar 

  24. Tucker SM, Alexandrescu S (2016) Updates and review of neoplastic paediatric neuropathology. Diagn Histopathol 22:431–438

    Article  Google Scholar 

  25. Wood MD, Halfpenny AM, Moore SR (2019) Applications of molecular neuro-oncology - a review of diffuse glioma integrated diagnosis and emerging molecular entities. Diagn Pathol 14:29

    Article  Google Scholar 

  26. Pollack IF, Agnihotri S, Broniscer A (2019) Childhood brain tumors: current management, biological insights, and future directions. J Neurosurg Pediatr 23:261–273

    Article  Google Scholar 

  27. Mosaab A, El-Ayadi M, Khorshed EN, Amer N, Refaat A, El-Beltagy M, Hassan Z, Soror SH, Zaghloul MS, El-Naggar S (2020) Histone H3K27M Mutation Overrides Histological Grading in Pediatric Gliomas. Sci Rep 10:8368

    Article  CAS  Google Scholar 

  28. Brown TJ, Brennan MC, Li M, Church EW, Brandmeir NJ, Rakszawski KL, Patel AS, Rizk EB, Suki D, Sawaya R, Glantz M (2016) Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol 2:1460–1469

    Article  Google Scholar 

  29. Xia L, Fang C, Chen G, Sun C (2018) Relationship between the extent of resection and the survival of patients with low-grade gliomas: a systematic review and meta-analysis. BMC Cancer 18:48

    Article  Google Scholar 

  30. Cao L, Li C, Zhang Y, Gui S (2015) Surgical resection of unilateral thalamic tumors in adults: approaches and outcomes. BMC Neurol15(1):1–13

  31. Zhang P, Wang X, Ji N, Xie J, Han J, Ren X, Song G, Wu R, Zhang L, Gao Z (2016) Clinical, radiological, and pathological features of 33 adult unilateral thalamic gliomas. World J Surg Oncol 14(1):1–11

  32. Wu B, Tang C, Wang Y, Li Z, Hu S, Hua W, Li W, Huang S, Ma J, Zhang Y (2018) High-grade thalamic gliomas: Microsurgical treatment and prognosis analysis. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia 49:56–61

    Article  Google Scholar 

  33. Esquenazi Y, Moussazadeh N, Link TW, Hovinga KE, Reiner AS, DiStefano NM, Brennan C, Gutin P, Tabar V (2018) Thalamic glioblastoma: clinical presentation, management strategies, and outcomes. Neurosurgery 76–85

  34. Nishio S, Morioka T, Suzuki S, Takeshita I, Fukui M (1997) Thalamic gliomas: a clinicopathologic analysis of 20 cases with reference to patient age. Acta Neurochir (Wien) 139:336–342

    Article  CAS  Google Scholar 

  35. Franzini A, Leocata F, Cajola L, Servello D, Allegranza A, Broggi G (1994) Low-grade glial tumors in basal ganglia and thalamus: natural history and biological reappraisal. Neurosurgery 35:817–820; discussion 820–811

  36. Gnekow AK, Falkenstein F, von Hornstein S, Zwiener I, Berkefeld S, Bison B, Warmuth-Metz M, Driever PH, Soerensen N, Kortmann RD, Pietsch T, Faldum A (2012) Long-term follow-up of the multicenter, multidisciplinary treatment study HIT-LGG-1996 for low-grade glioma in children and adolescents of the German Speaking Society of Pediatric Oncology and Hematology. Neuro Oncol 14:1265–1284

    Article  CAS  Google Scholar 

  37. Bandopadhayay P, Bergthold G, London WB, Goumnerova LC, Morales La Madrid A, Marcus KJ, Guo D, Ullrich NJ, Robison NJ, Chi SN, Beroukhim R, Kieran MW, Manley PE (2014) Long-term outcome of 4,040 children diagnosed with pediatric low-grade gliomas: an analysis of the Surveillance Epidemiology and End Results (SEER) Database. Pediatr Blood Cancer 61:1173–1179

    Article  Google Scholar 

  38. Wong TT, Chen HH, Liang ML, Hsieh KLC, Yang YS, Ho DMT, Chang KP, Lee YY, Lin SC, Hsu TR, Chen YW, Yen SH, Chang FC, Guo WY, Chen KW, Kwang WK, Hou WY, Wang CY (2016) Clinical considerations and surgical approaches for low-grade gliomas in deep hemispheric locations: thalamic lesions. Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery 32:1895–1906

    Article  Google Scholar 

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

    Article  Google Scholar 

  40. Lequin M, Hendrikse J (2017) Advanced MR imaging in pediatric brain tumors, clinical applications. Neuroimaging Clin N Am 27:167–190

    Article  Google Scholar 

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

    Article  Google Scholar 

  42. Kis D, Máté A, Kincses ZT, Vörös E, Barzó P (2014) The role of probabilistic tractography in the surgical treatment of thalamic gliomas. Operative Neurosurgery 10(2):262–272; discussion 272

  43. Singhal A, Hengel AR, Steinbok P, Cochrane DD (2015) Intraoperative ultrasound in pediatric brain tumors: does the surgeon get it right? Childs Nerv Syst 31:2353–2357

    Article  Google Scholar 

  44. Moiyadi AV, Shetty P, Degaonkar A (2017) Resection of pediatric brain tumors: intraoperative ultrasound revisited. J Pediatr Neurosci 19–23

  45. Avula S, Mallucci CL, Pizer B, Garlick D, Crooks D, Abernethy LJ (2012) Intraoperative 3-Tesla MRI in the management of paediatric cranial tumours—initial experience. Pediatr Radiol 42:158–167

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatric Neurosurgery, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK

    Geraint Sunderland, Mitchell T. Foster, Dawn Hennigan, Benedetta Pettorini & Conor Mallucci

  2. Cancer Research UK Brain Tumour Centre of Excellence, The University of Edinburgh, Edinburgh, UK

    Mitchell T. Foster

  3. Department of Paediatric Oncology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK

    Barry Pizer

Authors
  1. Geraint Sunderland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mitchell T. Foster
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barry Pizer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dawn Hennigan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benedetta Pettorini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Conor Mallucci
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Geraint Sunderland, Mitchell Foster, Dawn Hennigan, and Benedetta Pettorini. The first draft of the manuscript was written by Geraint Sunderland, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Geraint Sunderland.

Ethics declarations

Ethical approval

Institutional ethical approval was obtained for the collection and analysis of anonymised prospectively and retrospectively obtained data.

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sunderland, G., Foster, M.T., Pizer, B. et al. Evolution of surgical attitudes to paediatric thalamic tumours: the alder hey experience. Childs Nerv Syst 37, 2821–2830 (2021). https://doi.org/10.1007/s00381-021-05223-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-021-05223-7

Keywords

Search

Navigation