Abstract
The thalamic lesion is one of the most challenging tumors with significant mortality and morbidities. Current literature highlights the importance of individualized treatment strategies tailored to the specific characteristics of the lesion and the patient. In terms of efficacy, studies have demonstrated that maximal safe resection (MSR) of thalamic lesions can lead to better tumor control, prolonged progression-free survival, and improved overall survival rates compared to biopsy alone. However, the feasibility of achieving MSR is highly dependent on the location, size, and histology of the lesion, as well as the patient's functional status and overall health. Also, surgical interventions in the thalamus carry inherent risks of neurological deficits, including sensory, motor, and cognitive impairments, depending on the extent of surgical resection and proximity to eloquent neural structures. On the other hand, biopsy remains a valuable diagnostic tool for obtaining tissue samples and establishing a definitive histological diagnosis in cases where MSR is not feasible or poses a high risk of neurological complications. Indeed, biopsy is preferred in patients with advanced age, significant comorbidities, or lesions located in eloquent regions of the thalamus where aggressive surgical resection may result in considerable morbidity. Quality of life (QoL) outcomes, including functional status, symptom burden, and overall well-being, are important endpoints in evaluating the impact of treatment approaches for thalamic lesions on patients' daily activities. While MSR may offer potential long-term benefits in terms of tumor control and survival outcomes, it may also be associated with a higher risk of neurological deficits and functional impairments that can impact QoL postoperatively. Conversely, biopsy may involve less invasive procedures and shorter recovery times, resulting in better preserved functional status and improved QoL in selected patient populations.