Tumors of the Thalamus and Basal Ganglia

Basal ganglia tumors (BGT) include tumors arising from the thalamus, nucleus caudatus and lenticularis. Histopathologically, they are mostly of glial origin with a prevalence of astrocytomas. Primary BGT represent 1–5% of intracranial neoplasms in adults and 5–15% in children. As they grow, they infiltrate the normal gray-matter nuclei and white matter tracts and spread downward the brainstem, causing neurological deterioration (cognitive, sensitive and motor deficit, upper cranial nerves palsies, seizures) and obstructive hydrocephalus. Surgery is the treatment of choice for unilateral low-grade glial tumors and plays a role combined with adjuvant treatment in high-grade cases. Surgical morbidity has been significantly reduced after the introduction of advanced imaging and portal systems. Biopsy, followed by adjuvant treatment, is indicated if gross total resection (GTR) is not feasible. We present our experience of 16 patients with basal ganglia tumors treated at our institution between 2008 and 2021. These tumors were preferentially treated using a transcortical transtubular (portal system) approach, with GTR achieved in 75% of cases. Most of the patients received adjuvant treatment. At last follow-up (mean 24.6 months), we observed a 24.9-month OS. Surviving patients showed a good performance status with only one case of severe disability.