P10.06 surgical selection for 23 thalamic gliomas

Background: The ideal surgical approach to thalamic gliomas varies according to their location within the thalamus and consideration of adjuvant vital structures. We report 23 cases of thalamic gliomas treated via various surgical approach. Methods: A retrospective study over a 11-year period (from 2005 to 2016) was performed in 23 patients (1 patient received 2 operation due to recurrence) with thalamic tumors. We reviewed the clinical presentation, surgical approach, perioperative mortality and morbidity and outcomes of 23 operated patients with thalamic tumor. The seletion of the surgical approach for thalamic gliomas was based on the exact location and extension of the tumors and the location of the motor fibers in relation to the tumor. The location of the the motor fibers was identified on the diffusion tensor image and the shortest route to reach the tumor without injuring the motor fibers and disrupting the uninvolved thalamus was decided based on the axial and coronal contrast images. Results: This study included 14 males and 9 females with a mean age of 39.2 years (range 9- 68 years). The most common symptoms were motor deficits(52.2%, 12/23patients) and mental confusion(21.7%, 5/23patients). Most common approaches were transcortical transventricular approach(9, 37.5%). The other approaches were transcortical approach (5, 20.8%), anterior and posterior interhemispheric transcallosal approach (4, 16.6%), occipital transtentorial approach (4, 16.6%), eyebrow approach (The modified lateral supraorbital approach) (1, 4.1%) and transsylvian-transinsular approach (1, 4.1%). The most common location was the posterolateral thalamus (6, 26%). The glioblastoma (12, 52.1%) was the most common pathology followed by anaplastic astrocytoma (4,17.4%), diffuse astrocytoma(3, 13.0%), pilocytic astrocytoma(2, 8.7%), etc. All patients underwent maximal safe tumor resection with awaken craniotomy and/or navigation assisted insertion of tumor markers. Gross total resection was achieved in 15 cases(65.2%), subtotal resection in 4cases(17.4%), and partial resection in 4 cases(17.4%). Mean survival of glioblastoma and WHO grade III glioma patients were 22.6 months and 25.4 months, respectively. Conclusions: Surgical selection for thalamic tumors must be individualized according to tumor location within the thalamus and the extension of the tumor. Also the relation of the motor tract and the tumor is very important. Gross total resection can be achieved in thalamic gliomas with acceptable complications and conferred a better prognosis