Pediatric Thalamic Tumors: Management Strategies and Outcomes

Keywords: children, astrocytoma, thalamus, brain tumor, outcome

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     Thalamic tumors are rare in the pediatric population. Their location in a highly functional region of the brain presents significant management challenges.
     We present our experience with pediatric thalamic tumors at Children’s Hospital Boston/Dana Farber Cancer Institute.
     43 male and 39 female patients with thalamic tumors were identified.
     82 patients with thalamic tumors treated between 1982 and 2011 were retrospectively reviewed. The clinical presentation, imaging findings, clinical management, histopathologic diagnosis, and outcome were analyzed.
     Presenting symptoms included headache (40.2%), seizure (6.1%), weakness (32.9%), sensory symptoms (1.2%), visual symptoms (13.4%), altered mental status (1.2%), and cranial neuropathy (3.7%). 4.9% were asymptomatic at time of diagnosis. 45.3% of tumors were found in the left thalamus, 41.3% in the right, and 13.3% were found to be bilateral. Pathologic diagnosis was low grade in 54.2% and high grade in 45.8%. Radiographic features demonstrated hydrocephalus in 29.3% of tumors, a cystic component in 24.3%, and calcifications in 3.7%. Tumor size ranged from less than 1 cm in 2.4%, between 1 and 5 cm in 75.6%, and greater than 5 cm in 15.9%. 43.9% of patients were treated for hydrocephalus: half with shunt placement and half with ETV. Among patients with low-grade pathology, overall survival was 83.3% and progression free survival was 79.1%. Overall survival among patients with high-grade pathology was 29.6% with no progression free survivors.
     This is a retrospective study.
     Our series revealed a majority of low-grade tumors, with many long-term survivors.
     Outcomes were analyzed by tumor grade, location, and surgical and clinical management strategies.


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