Pediatric thalamic incidentalomas: an international retrospective multicenter study

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  • 1 Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel;
  • | 2 Division of Neurosurgery, Children’s National Medical Center, Washington, DC;
  • | 3 Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee;
  • | 4 Department of Neurosurgery, Santobono-Pausilipon Children’s Hospital, Naples, Italy;
  • | 5 Institute of Neurosurgery, Catholic University of the Sacred Heart, Milan, Italy;
  • | 6 Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin, Germany;
  • | 7 Division of Pediatric Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah;
  • | 8 Department of Neurosurgery, VIMS and Park Clinic, Kolkata, India;
  • | 9 Department of Neurosurgery and Pediatric Neurosurgery, University and Children’s Hospital of Basel, Switzerland;
  • | 10 Faculty of Medicine, University of Basel, Switzerland;
  • | 11 Department of Surgery, Connecticut Children’s, Hartford, Connecticut; and
  • | 12 Departments of Surgery and Pediatrics, UConn School of Medicine, Farmington, Connecticut
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OBJECTIVE

Widespread use of modern neuroimaging has led to a surge in diagnosing pediatric brain incidentalomas. Thalamic lesions have unique characteristics such as deep location, surgical complexity, and proximity to eloquent neuronal structures. Currently, the natural course of incidental thalamic lesions is unknown. Therefore, the authors present their experience in treating such lesions.

METHODS

A retrospective, international multicenter study was carried out in 8 tertiary pediatric centers from 5 countries. Patients were included if they had an incidental thalamic lesion suspected of being a tumor and were diagnosed before the age of 20 years. Treatment strategy, imaging characteristics, pathology, and the outcome of operated and unoperated cases were analyzed.

RESULTS

Overall, 58 children (23 females and 35 males) with a mean age of 10.8 ± 4.0 years were included. The two most common indications for imaging were nonspecific reasons (n = 19; e.g., research and developmental delay) and headache unrelated to small thalamic lesions (n = 14). Eleven patients (19%) underwent early surgery and 47 were followed, of whom 10 underwent surgery due to radiological changes at a mean of 11.4 ± 9.5 months after diagnosis. Of the 21 patients who underwent surgery, 9 patients underwent resection and 12 underwent biopsy. The two most frequent pathologies were pilocytic astrocytoma and WHO grade II astrocytoma (n = 6 and n = 5, respectively). Three lesions were high-grade gliomas.

CONCLUSIONS

The results of this study indicate that pediatric incidental thalamic lesions include both low- and high-grade tumors. Close and long-term radiological follow-up is warranted in patients who do not undergo immediate surgery, as tumor progression may occur.

ABBREVIATIONS

DWI = diffusion-weighted imaging; LGG = low-grade glioma; HGG = high-grade glioma; MT = malignant transformation; T1WI = T1-weighted imaging; T2WI = T2-weighted imaging.

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