Pulvinar Locus is Highly Relevant to Patients' Outcomes in Surgically Resected Thalamic Gliomas in Children

• Published in: World neurosurgery 2020-02, Vol.134, p.e530-e539
• Main Authors: Chiba, Kentaro, Aihara, Yasuo, Masui, Kenta, Abe, Kayoko, Komori, Takashi, Kawamata, Takakazu
• Format: Article
• Language: English
• Subjects: Adolescent; BRAF V600E; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - mortality; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Child; Female; Follow-Up Studies; Glioma - diagnostic imaging; Glioma - mortality; Glioma - pathology; Glioma - surgery; H3F3A; Histology; Histones - genetics; Humans; Infant; Male; Mutation; Neoplasm Grading; Neoplasm Recurrence, Local; Prognosis; Pulvinar; Pulvinar - diagnostic imaging; Pulvinar - pathology; Pulvinar - surgery; Retrospective Studies; Thalamic glioma
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.10.116

Thalamic gliomas in children are less suitable for surgical resection because of their location. In cases of unavoidable resection, careful surgical planning in addition to histology and extent of resection affects prognosis. A cohort of 10 pediatric patients with thalamic glioma underwent surgical resection at our department. The predominant location of tumor origins in the thalamus was defined in imaging studies. Histopathology was determined (retrospectively in a subset) according to the World Health Organization classification 2016, including the newly established type of “diffuse midline glioma, H3 K27M-mutant.” Three low-grade gliomas (grade I/II) and 7 high-grade gliomas (grade III/IV) were identified. The mean follow-up period was 49.8 months. All 3 low-grade gliomas did not recur (progression-free survival, 58.3 months). Six of 7 high-grade gliomas recurred, and the patients died of the primary disease (overall survival, 28.1 months). Poor outcomes, especially when located at the pulvinar region, were noticeable, with strong predictive power for poor prognosis (P = 0.0018). The presence of H3 K27M mutation and pulvinar location were closely associated (P = 0.0036). Four of 5 patients with pulvinar region tumors developed dissemination and died of the primary disease. Pulvinar location is specifically associated with a high rate of malignancy in histology, the presence of H3 K27M mutation, and dissemination at an early disease stage. This association suggests that a distinct biological profile affects prognosis depending on location within the thalamus, especially the pulvinar. We report that tumor location is highly relevant to prognosis and should be taken into consideration when planning treatment.