STMO-14 SURGICAL MANAGEMENT OF DEEP-SEATED GLIOMA AROUND THALAMUS

BACKGROUND: Higher extent of resection contributes to better prognosis of the patients with glioma. However, resection of deep-seated glioma represents a surgical challenge not only because of the depth but because of adjacent eloquent structures such as pyramidal tract, deep venous system, and brainstem. METHODS: We performed a retrospective review of patients with deep-seated glioma around thalamus who underwent surgery between March 2014 and February 2019. The tumors were removed with use of neuronavigation, DTI tractography, electrophysiological monitoring and photo dynamics diagnosis using aminolevulinic acid via interhemispheric or transcortical approach. Volumetric analysis of preoperative tumor volume as well as postoperative residual volumes was performed. RESULTS: A total of 17 patients, ages ranged from 13–79 years (median; 51) were eligible. Twelve patients underwent radical resection and 5 underwent biopsy (2 with craniotomy, 2 with endoscopy, and 1 stereotactic biopsy). Pathological diagnosis consisted of glioblastoma (GBM) in 10, diffuse midline glioma (DMG) in 3, anaplastic astrocytoma in 3, and diffuse astrocytoma in 1. Extent of resection of the patients attempted radical resection was 96.7%±6.4%. Postoperatively, 12 patients developed hemianopsia, 2 had hemiparesis because of corticospinal tract injury, 2 sensory disturbance, and 3 cognitive dysfunction. At 1 month after surgery, Karnofsky performance status (KPS) worsened in 5 GBM patients and 1 DMG patient, while improved or stable in the rest 11 patients. CONCLUSION: Resection of deep-seated glioma around thalamus accompanies a high risk of neurological deficits. Nevertheless, radical resection without KPS decline can be achieved by preserving the corticospinal tract, deep venous system, and brainstem and minimizing damages of surrounding brain.