Strategy of Adult Thalamic Glioma Surgery: Thoughts and Practices based on Thalamic Glioma Classification
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Objectives Adult thalamic gliomas (ATGs) pose a substantial surgical challenge because of their deep-seated location and proximity to critical brain regions. To standardize the surgical approaches, we proposed the HX-MaoQing classification which classified thalamic gliomas into four distinct zones, each associated with specific surgical approaches. Method This retrospective study included 201 patients (median age 40 years) with WHO grade 2–4 thalamic gliomas treated at West China Hospital from 2012 to 2024. Survival outcomes were analyzed using Kaplan–Meier analysis alongside log-rank test. Associations between clinical characteristics were evaluated using Cramer's V coefficient. Result Tumors invading multiple zones were the most prevalent, accounting for 23.88% of cases, whereas only 1.98% involved both cerebral hemispheres. Supra-tentorial lateral approaches were most utilized (51.4%), while no cases required supracerebellar infratentorial access. Median overall survival was 10 months. Extended survival correlated strongly with complete resection rates(p = 0.0087), which varied significantly by tumor location (Cramer's V = 0.435, p < 0.001) and tumor size (Cramer's V = 0.201, p < 0.01). Within certain zones, surgical approaches may correlate with EOR. Conclusion The transcallosal anterior approach is recommended for midline tumors located in Zones III, IV, or III + IV, particularly in cases involving obstructive hydrocephalus. For posterolateral tumors in Zones II and II + III, the approach should be determined based on the direction of tumor growth. Tumors in Zone I are most effectively managed through the cortical-lateral ventricle-choroid fissure route. Nevertheless, further research with larger sample sizes is necessary to refine and optimize treatment strategies for thalamic gliomas.