Clinico-radiological analysis and outcomes of management of thalamic space-occupying lesions: A three-year retrospective case series

Abstract

Background and Objective: Thalamic tumors are rare, deep-seated tumors with a paucity of literature globally, and yet no existing literature based on the Pakistani population. The objective of this study was to evaluate the clinical presentations and radiological findings of thalamic space-occupying lesions (SOLs) and analyze the outcomes of management practices.

Methodology: A bi-departmental retrospective observational case series of 13 patients who underwent surgical excision or cerebrospinal fluid (CSF) diversion for thalamic SOLs at the Punjab Institute of Neurosciences (PINS) Hospital from 1st January 2022 to 31st December 2024. A descriptive analysis was done for clinical-radiological and outcome-based variables.

Results: The cohort comprises 33% (4) pediatric patients (mean age, 8.75±6.07 years) and 67% (9) adults (mean age, 33.67±14.82 years), with a male predilection of 56.3% (9). The most common presentation was focal neurological deficit in 77% (10). Magnetic Resonance Imaging (MRI) revealed that tumors were hypointense on T1-weighted images (T1WI) in 77% (10) of patients and hyperintense on T2-weighted images (T2WI) in 92% (12), with 77% (10) of them being contrast enhancing. Ventriculoperitoneal Shunt (VPS) was required in 15% (2) of patients, improvement of Glasgow Coma Scale (GCS) was in 15% (2), and Karnofsky Performance Status (KPS) after surgery was improved in 23% (3). Glioblastoma 61.5% (8) was the most common diagnosis on histopathology.

Conclusion: High-grade thalamic gliomas usually affect adult males and present with focal neurological symptoms in the Pakistani population, requiring MRI with Gadolinium contrast evaluation for the diagnosis. Neuronavigation-guided (NNG) biopsy is the common modality of neurosurgical intervention, with minimal improvement, and glioblastoma, the common histopathological diagnosis for thalamic tumors.