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Distant recurrences limit the survival of patients with thalamic high-grade gliomas after successful resection

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Abstract

The indications of surgery for thalamic high-grade gliomas are not well established. The present study investigated the outcome of 21 patients treated by surgery and reports the high incidence of distant recurrences including disseminations after successful removal. Twenty-one patients with thalamic high-grade gliomas not invading the pyramidal tract or midbrain underwent cytoreductive surgery at our institute from June 1997 to August 2015. Surgery was performed with the aid of a neuronavigation system, electrophysiological monitoring, and fluorescence navigation. Tumor histology included 12 cases of the World Health Organization grade III and nine cases of grade IV. Gross total resection was achieved in six cases, subtotal in 13, and partial in two. Motor weakness accompanied by sensory disturbance deteriorated immediately after surgery in 13 patients. However, five patients were determined to show deterioration at 2 months after surgery. Postoperative radiation and chemotherapy were given to every patient, and median progression-free survival of patients with grade III and IV tumors was 12.1 and 7.0 months, respectively. Median overall survival of patients with grade III and IV tumors was 25.6 and 12.6 months, respectively. High incidence of distant recurrences was found, with distant lesions at recurrence in 13 of 19 patients with recurrence, suggesting the life-restricting factor in these patients. Thalamic high-grade glioma without invasion into the pyramidal tract and brainstem can be considered as a candidate for surgical resection. Distant lesion limits the survival of patients after successful resection.

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Acknowledgements

The authors have no study funding sources. The data presented and the statements made are solely the responsibility of the authors.

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Authors and Affiliations

  1. Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Ryuta Saito, Toshihiro Kumabe, Masayuki Kanamori, Yukihiko Sonoda & Teiji Tominaga

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  1. Ryuta Saito
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  2. Toshihiro Kumabe
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  3. Masayuki Kanamori
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  4. Yukihiko Sonoda
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  5. Teiji Tominaga
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Correspondence to Ryuta Saito.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Supplementary Fig 1

Schema for surgical strategy; high parietal transcortical transventricular approach. 1st step (arrow 1); transcortical and transventricular approach to the thalamus. 2nd step (arrow 2); identification of internal cerebral vein, 3rd step (arrow 3); separation of ICV from tela choroidea and identification of 3rd ventricle. 4th step; removal of tumor without damaging the pyramidal tract. (GIF 471 kb)

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Saito, R., Kumabe, T., Kanamori, M. et al. Distant recurrences limit the survival of patients with thalamic high-grade gliomas after successful resection. Neurosurg Rev 40, 469–477 (2017). https://doi.org/10.1007/s10143-016-0804-x

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  • DOI: https://doi.org/10.1007/s10143-016-0804-x

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