Surgical Management of Thalamic Tumors
Summary
Thalamic tumours present a unique neurosurgical challenge owing to their deep-seated location, complex surrounding anatomy and heterogeneity in histological grade. Surgical strategies now centre on maximising safe resection while preserving vital thalamocortical pathways. Advances in preoperative planning incorporate diffusion tensor imaging (DTI) tractography to delineate motor and sensory fibres, and intraoperative neurophysiological monitoring to detect functional compromise in real time. Approaches are tailored to tumour epicentre, utilising transparieto-occipital, trans-ventricular or trans-callosal corridors as indicated. The extent of resection has repeatedly been linked to improved overall and progression-free survival, particularly in low-grade gliomas, yet must be balanced against the risk of postoperative deficits such as hemiparesis or sensory loss. Current practice often integrates endoscopic third ventriculostomy for hydrocephalus prophylaxis and intraoperative MRI to verify resection margins. Multidisciplinary collaboration remains essential to incorporate molecular profiling, adjuvant therapies and rehabilitation into a personalised treatment pathway.
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Surgical Management of Thalamic Tumors publication trend
The graph below shows the total number of articles in surgical management of thalamic tumors across all publications each year (not limited to Nature Index journals).
Technical terms
Gross total resection (GTR): Surgical removal of all visible tumour on postoperative imaging.
Subtotal resection (STR): Removal of the majority but not all tumour tissue, typically defined as ≥ 80% volume reduction.
Diffusion tensor imaging (DTI): Magnetic resonance technique mapping white-matter tracts by measuring water diffusion.
Karnofsky Performance Status (KPS): Scale assessing a patient’s functional impairment and ability to carry out daily activities.
Endoscopic third ventriculostomy (ETV): Minimally invasive procedure creating an alternative cerebrospinal fluid pathway to relieve hydrocephalus.
References
- Are Thalamic Intrinsic Lesions Operable? No-Man’s Land Revisited by the Analysis of a Large Retrospective, Mono-Institutional, Cohort. Cancers (2023).
- Risk Factors for Early Hydrocephalus on Post Unilateral Thalamic Tumor Resection. Frontiers in Surgery (2022).
- Surgical Treatment of Paediatric Thalamic Gliomas—Single-Centre Experience. Brain Sciences (2024).
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