Brain Tumor Research and Treatment

The Korean Brain Tumor Society (대한뇌종양학회)
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Surgical Outcomes of Thalamic Tumors in Children: The Importance of Diffusion Tensor Imaging, Neuro-Navigation and Intraoperative Neurophysiological Monitoring

  • Kim, Jun-Hoe (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Phi, Ji Hoon (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lee, Ji Yeoun (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Kyung Hyun (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Park, Sung-Hye (Department of Pathology, Seoul National University College of Medicine) ;
  • Choi, Young Hun (Division of Pediatric Radiology, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Cho, Byung-Kyu (Department of Neurosurgery, The Armed Forces Capital Hospital) ;
  • Kim, Seung-Ki (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2018.08.15
  • Accepted : 2018.09.19
  • Published : 2018.10.31
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Abstract

Background Recently, modern technology such as diffusion tensor imaging (DTI), neuro-navigation and intraoperative neurophysiological monitoring (IOM) have been actively adopted for the treatment of thalamic tumors. We evaluated surgical outcomes and efficacy of the aforementioned technologies for the treatment of pediatric thalamic tumors. Methods We retrospectively reviewed clinical data from 37 children with thalamic tumors between 2004 and 2017. There were 44 operations (27 tumor resections, 17 biopsies). DTI was employed in 17 cases, neuro-navigation in 23 cases and IOM in 14 cases. All diagnoses were revised according to the 2016 World Health Organization Classification of Tumors of the Central Nervous System. Progression-free survival (PFS) and overall survival (OS) rates were calculated, and relevant prognostic factors were analyzed. The median follow-up duration was 19 months. Results Fifteen cases were gross total resections (GTR), 6 subtotal resections (STR), and 6 partial resections (PR). Neurological status did not worsen after 22 tumor resections. There were statistically significant differences in terms of the extent of resection between the groups with DTI, neuro-navigation and IOM (n=12, GTR or STR=12) and the group without at least one of the three techniques (n= 15, GTR or STR=9, p=0.020). The mean PFS was $87.2{\pm}38.0$ months, and the mean OS $90.7{\pm}36.1$ months. The 5-year PFS was 37%, and the 5-year OS 47%. The histological grade ($p{\leq}0.001$) and adjuvant therapy (done vs. not done, p=0.016) were significantly related to longer PFS. The histological grade (p=0.002) and the extent of removal (GTR/STR vs. PR/biopsy, p=0.047) were significantly related to longer OS. Conclusion Maximal surgical resection was achieved with acceptable morbidity in children with thalamic tumors by employing DTI, neuro-navigation and IOM. Maximal tumor resection was a relevant clinical factor affecting OS; therefore, it should be considered the initial therapeutic option for pediatric thalamic tumors.

Keywords

Acknowledgement

Supported by : NRF

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