title: Thalamic tumors in children: a reappraisal.
abstract: OBJECTIVE
  Two to five percent of pediatric brain tumors are located in the thalamus. The optimal management for these tumors remains unclear. The aim of this study was to determine whether clinical and neuroimaging features could guide treatment, and to what extent these features, together with histological diagnosis and treatment modalities, influenced survival.
  
  
  METHODS
  The records of 69 children who presented with a thalamic tumor between 1989 and 2003 were retrospectively reviewed. Three groups of tumors were analyzed separately: 1) unilateral thalamic tumors (54 lesions); 2) thalamopeduncular tumors (six); and 3) bilateral thalamic tumors (nine). In the patients in whom a unilateral thalamic tumor was diagnosed, 33 had an astrocytic tumor. Of the 54 patients, 32 had a low-grade and 22 had a high-grade tumor. The survival rate was significantly better for patients with the following characteristics: symptom duration longer than 2 months (p < 0.001), lesions with low-grade histological features (p = 0.003), and tumor excision greater than 90% at surgery (p = 0.04). The perioperative morbidity and mortality rates were 37 and 4%, respectively. Fifty-four percent of the patients in this group had a long-term and independent survival. The thalamopeduncular tumors were mostly pilocytic astrocytomas, which had a good prognosis following surgery. The bilateral thalamic tumors in this series were mainly low-grade astrocytic lesions, and more than half of the children attained long-term survival (mean follow-up duration 4.5 years).
  
  
  CONCLUSIONS
  The majority of tumors arising in the thalamus are astrocytic, of which less than half are high-grade lesions. Histological evaluations should be performed in all patients in whom resection is being considered for discrete lesions. Long-term survival is possible in patients with these tumors.
authors.affiliation: Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Puget
authors.forename: Darach W
authors.initials: DW
authors.lastname: Crimmins
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Garnett
authors.forename: Jacques
authors.initials: J
authors.lastname: Grill
authors.forename: Ricardo
authors.initials: R
authors.lastname: Oliveira
authors.forename: Nathalie
authors.initials: N
authors.lastname: Boddaert
authors.forename: Alison
authors.initials: A
authors.lastname: Wray
authors.forename: Arielle
authors.initials: A
authors.lastname: Lelouch-Tubiana
authors.forename: Thomas
authors.initials: T
authors.lastname: Roujeau
authors.forename: Federico
authors.initials: F
authors.lastname: Di Rocco
authors.forename: Michel
authors.initials: M
authors.lastname: Zerah
authors.forename: Christian
authors.initials: C
authors.lastname: Sainte-Rose
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000175:diagnosis / Q000628:therapy; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D007223:Infant; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D011379:Prognosis; D012189:Retrospective Studies; D013788:Thalamus / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed