Clinical Research Coordinator University of Miami Hospital Buenos Aires, Argentina
Introduction: Adult thalamic gliomas present a surgical challenge given their depth and proximity to eloquent brain regions. Choosing a surgical approach relies on different clinical variables such as anatomical location, size, and side of the tumor. Our objective is to systematically review the literature and analyze clinical data strongly focused on the surgical treatment of adult thalamic gliomas, and to provide tools that may improve the decision-making process.
Methods: Literature regarding the surgical management of thalamic gliomas in adult patients was reviewed according to the PRISMA guidelines. Four databases were searched with keywords “‘thalamic glioma’ AND (‘surgical intervention’ OR ‘surgical treatment’)”. A description of clinical characteristics and survival analysis was performed. An individual patient data analysis was conducted.
Results: A total of 462 patients were included from 13 studies that complied with the search criteria. The mean age was 38.05 years with a median preoperative KPS of 70. Molecular profile was not homogeneously reported across studies. The transcortical/transventricular approaches were most frequently used (43.1%), followed by transcallosal (24.2%). Gross total resection (GTR), subtotal resection (STR), and partial resection were achieved in 36.2%, 63.8%, and 15.6% of all cases, respectively. Transcortical and transcortical/transventricular approaches resulted in 72.2-79.2% of GTR/STR, while a 55.5% of transcallosal approach accomplished a GTR/STR. A 13% 30-day-postoperative mortality rate was reported. Adult patients' median overall survival (OS) after surgery was 17.7 months (10 - 23.7 months). Individual patient data were pooled from five studies. A multivariable hazard regression showed a statistically significant relationship between worse OS and tumors located within the medial (p=0.017) and posterior thalamus (p=0.003), as well as with high-grade gliomas (p=0.013).
Conclusion : Adult thalamic gliomas are challenging lesions that require a tailored surgical strategy. An anteriorly located low-grade glioma, operated through a transcortical/transventricular approach may be associated with a better OS.
