Táborská Jana, Horčičáková Katarína, Bubeníková Adéla, Táborský Jakub, Kynčl Martin, Koblížek Miroslav, Sumerauer David, Zápotocký Michal, Pavelka Zdeněk, Bradáč Ondřej, Beneš Vladimír
Department of Neurosurgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
Center for Pediatric Neuro-Oncology, University Hospital Motol, V Úvalu 84, Prague, 150 00, Czech Republic.
Acta Neurochir (Wien). 2025 Aug 8;167(1):218. doi: 10.1007/s00701-025-06632-2.
The increasing availability of advanced neuroimaging has led to a rise in incidental findings among pediatric patients. Management strategies include immediate surgical intervention, observation or surgery upon progression. These are influenced by imaging characteristics, lesion behavior over time, patient/family preferences, and the lesion's surgical risks. The thalamus's eloquent location often warrants a more conservative approach. Identifying features predictive of growth could help inform clinical decisions regarding surveillance and potential intervention.
We retrospectively analyzed 44 pediatric patients with 46 thalamic incidentalomas, assessing radiological characteristics, temporal changes, and factors predictive of progression. Progression was defined as a change in size and/or new/increased contrast enhancement. Prognostic factors for progression (demographics, initial tumor volume, extension beyond thalamus, changes in enhancement, margin characteristics) were assessed for significance.
Of 46 incidentalomas, 40 were followed longitudinally. Nine incidentalomas (22.5%) showed regression, while nine (22.5%) progressed. The average time to regression was 947 days, and to progression, 516 days. Three patients underwent biopsy due to progressive changes; each was diagnosed with low-grade glioma. Statistical analysis revealed that initial incidentaloma volume, extension beyond the thalamus, and contrast enhancement were significantly associated with progression (p = 0.025, p < 0.001, and p = 0.001, respectively).
Most pediatric thalamic incidentalomas are small, stable, and likely low-grade. However, approximately one-fifth exhibit progressive features, warranting prolonged surveillance. Larger initial volume, extra-thalamic extension, and contrast enhancement are significant predictors of progression and may justify earlier intervention. Individualized management remains essential, balancing natural history with surgical risk.
先进神经影像学检查的日益普及导致儿科患者中偶然发现的情况增多。管理策略包括立即手术干预、观察或病情进展时手术。这些策略受影像特征、病变随时间的行为、患者/家属偏好以及病变的手术风险影响。丘脑的明确位置通常需要采取更保守的方法。识别可预测生长的特征有助于为有关监测和潜在干预的临床决策提供依据。
我们回顾性分析了44例患有46个丘脑偶然瘤的儿科患者，评估其放射学特征、时间变化以及进展的预测因素。进展定义为大小改变和/或新的/增强的对比增强。评估进展的预后因素（人口统计学、初始肿瘤体积、丘脑外扩展、增强变化、边缘特征）的显著性。
46个偶然瘤中，40个进行了纵向随访。9个偶然瘤（22.5%）显示缩小，9个（22.5%）进展。缩小的平均时间为947天，进展的平均时间为516天。3例患者因病情进展性变化接受活检；每例均被诊断为低级别胶质瘤。统计分析显示，初始偶然瘤体积、丘脑外扩展和对比增强与进展显著相关（分别为p = 0.025、p < 0.001和p = 0.001）。
大多数儿科丘脑偶然瘤体积小、稳定，可能为低级别。然而，约五分之一表现出进展性特征，需要延长监测时间。初始体积较大、丘脑外扩展和对比增强是进展的重要预测因素，可能证明早期干预是合理的。个体化管理仍然至关重要，要平衡其自然病程和手术风险。
