Fig 1.
Inclusion and exclusion criteria of participants.
From January 2010 to December 2017, the data of 76 patients with thalamic glioma were collected from Bundang CHA Medical Center. We excluded the early on-set patients under 18 years of age (n = 4) and elderly patients above 70 years of age (n = 5). Patients with non-primary glioblastoma, including lower grade gliomas (grade I, II, and III) (n = 11), secondary or recurrent glioblastoma (n = 3), H3K27 mutant glioma (n = 2), and pathologically unclassified tumors (n = 6) were excluded. In addition, we excluded patients for whom there was no information concerning O6- methylguanine- DNA methyltransferase methylation status and who were lost to follow-up. Finally, 42 total patients with thalamic glioblastoma were included in this study.
Fig 2.
Treatment strategies and patient selection.
In cases of suspected thalamic glioblastoma, surgical resection is the treatment of choice in our hospital (n = 19). Biopsy was considered when there was ventricle wall enhancement, leptomeningeal enhancement, or multiple enhancement lesion in a distant location on magnetic resonance imaging (n = 18). Biopsy was performed in cases when the patient or family elected it (n = 6).
Fig 3.
Preoperative magnetic resonance image of a glioblastoma of the right posterior thalamus with lateral extension (A). The tailed bullets are inserted into the target areas (B). During the operation, intraoperative computed tomography image and the tailed bullet technique are used for enabling adjustment for brain shifting and the confirmation of target lesion (C, D).
Table 1.
Factors exhibiting clinical relevance.
Fig 4.
Survival analysis of surgical resection and biopsy groups.
A. The mean overall survival time (OS) was significantly longer in patients who underwent surgical resection compared to those who underwent biopsy based on treatment criteria (doctor selecting biopsy group) or those who elected biopsy (patient selecting biopsy group) (p < 0.001). B. Progression-free survival in the surgical resection group was significantly longer compared to the doctor selecting biopsy group or the patient selecting biopsy group (p < 0.001).
Table 2.
Multiple Cox-regression analysis.
Table 3.
Distribution of surgical and neurological complications between surgical resection and biopsy group.
Fig 5.
A 68-year-old man was admitted to our hospital with headache and blurred vision. Preoperative magnetic resonance imaging (MRI) showed a cystic and solid mass in a lateral thalamic lesion on T1-contrast enhanced (A) and T2-fluid-attenuated inversion recovery (FLAIR) high signal imaging (B). Postoperative MRI showed gross total resection of the tumor in T1-contrast enhanced images (C) and subtotal resection of the tumor in T2-FLAIR images (D). At the one-year follow-up MRI, there was irregular and fuzzy enhancement in T1-contrast-enhanced images (E) and a high signal in T2-FLAIR images (F). At the 2-year follow-up MRI, there was a stable state in T1-contrast enhanced images (G) and T2-FLAIR images (H). The patient is still alive, and the postoperative survival time is 1515 days.
Fig 6.
A 52-year-old woman was admitted to our hospital with confused mentality, diplopia and motor weakness. Preoperative magnetic resonance imaging (MRI) showed a cystic and solid mass in a medical posterior inferior thalamic lesion on T1-contrast enhanced (A) and T2-FLAIR high signal imaging (B). Postoperative MRI showed gross total resection of the tumor on T1-contrast enhanced images (C) and subtotal resection of the tumor on T2-FLAIR images (D). At the one-year follow up MRI, there was irregular enhancement on T1- contrast enhanced images (E) and high signal on T2-FLAIR images (F). At the 2-year follow-up MRI, there was a stable state on T1-contrast enhanced (G) and T2- FLAIR images (H). The patient is still alive, and the postoperative survival time is 1469 days.