{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:04:04Z","timestamp":1790787844890,"version":"4.1.0"},"reference-count":34,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Deep thalamic and periventricular lesions are uncommon in adults but can result in significant loss of function because of their convergence on three interdependent processes: thalamocortical state regulation, throughput of periventricular long association systems, and ventricular compartmental compliance. The resulting combination of executive control collapse, retrieval-weighted language fragility, and load-sensitive gait instability may occur early after a lesion forms an atrial\/posterior horn interface, and pressure-linked autonomic symptoms may be late to develop. Screening deficits will likely be minimal and therefore underreported. Objective\/Aim: To present a thalamic\u2013atrial\/posterior horn tumor case with quantified load-sensitive cognitive\u2013language\u2013gait dysfunction and to detail a physiology-guided, sequence-driven decompression approach emphasizing ventricular relaxation and perforator-preserving, interface-limited thalamic resection. Case Presentation: A 56-year-old female patient experienced a 3-month, rapidly progressive decline in her cognitive and language abilities. The clinical progression was not stepwise or punctuated by a single \u201csentinel\u201d event. She had a moderate level of cognitive impairment consistent with both Broca\u2019s and Wernicke\u2019s aphasias (MoCA: 22\/30) and suffered from significant interference effects and increased cost of task-switching. Her ability to generate novel responses and name objects was significantly impaired; however, she was able to repeat words and phrases appropriately. In addition, she exhibited a severe sustained attention signature and a high error rate during dual-task performance, indicating severe gait instability, although her overall global anchors were nearly neutral (GCS 15; FOUR 15\/16; NIHSS 2). Nausea and vomiting occurred simultaneously with the cognitive and language decline, suggesting decreased intracranial compliance. MRI revealed a heterogeneous left-sided thalamic tumor extending into the posterior horn of the lateral ventricle. The tumor caused deformation of the lateral ventricle and midline displacement. The patient underwent microsurgical intervention using a physiology-conscious sequence of graded cerebrospinal fluid (CSF) equilibration and primary mechanical removal of the tumor from the ventricular system. Additionally, decompression of the thalamus was performed in a manner that was cognizant of the boundaries formed by the perforating arteries of the thalamus. Early resolution of pressure symptoms was noted postoperatively. Objective measures demonstrated significant improvement in the patient\u2019s executive functioning, language skills, attentional errors, and dual-task performance stability. The patient remained functionally independent at discharge and at subsequent follow-up visits. Surveillance imaging did not demonstrate any evidence of tumor recurrence. Conclusions: The clinical presentation described above is supportive of a model in which the synergy between deep network damage and distortion of the posterior ventricular compartment amplifies network dysfunction. Additionally, the use of quantitative stress-phenotyping makes it possible to identify deep network pathology early in its course. Finally, the physiology-guided decompression approach that was used in this case has the potential to increase functional reserve in patients with pathology that requires millimeter transitions.<\/jats:p>","DOI":"10.3390\/diagnostics16060836","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T14:43:18Z","timestamp":1773240198000},"page":"836","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Left Pulvinar Thalamic Tumor with Ventricular Atrial Extension Presenting as Network-Level Cognitive and Gait Dysfunction"],"prefix":"10.3390","volume":"16","author":[{"given":"Florin Mihail","family":"Filipoiu","sequence":"first","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6296-8364","authenticated-orcid":false,"given":"Stefan","family":"Oprea","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9043-3690","authenticated-orcid":false,"given":"Cosmin","family":"Pantu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matei","family":"\u0218erban","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"},{"name":"Puls Med Association, 051885 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u0103zvan-Adrian","family":"Covache-Busuioc","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"},{"name":"Puls Med Association, 051885 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corneliu","family":"Toader","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"},{"name":"Puls Med Association, 051885 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mugurel Petrinel","family":"Radoi","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"},{"name":"Puls Med Association, 051885 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Octavian","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca Florentina","family":"Tulin","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 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Rep."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Zhang, L., Wang, C., and Zeng, X. (2022). Risk Factors for Early Hydrocephalus on Post Unilateral Thalamic Tumor Resection. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.814308"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9356","DOI":"10.1038\/s41598-024-59787-w","article-title":"Intrinsic Mechanisms of Right Ventricular Autoregulation","volume":"14","author":"Mechelinck","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1038\/s42003-022-04126-w","article-title":"Relay and Higher-Order Thalamic Nuclei Show an Intertwined Functional Association with Cortical-Networks","volume":"5","author":"Kumar","year":"2022","journal-title":"Commun. Biol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Alharthi, A.S. (2024). Interpretable Machine Learning Comprehensive Human Gait Deterioration Analysis. Front. Neuroinformatics, 18.","DOI":"10.3389\/fninf.2024.1451529"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Tuena, C., Pupillo, C., Stramba-Badiale, C., Stramba-Badiale, M., and Riva, G. (2024). Predictive Power of Gait and Gait-Related Cognitive Measures in Amnestic Mild Cognitive Impairment: A Machine Learning Analysis. Front. Hum. Neurosci., 17.","DOI":"10.3389\/fnhum.2023.1328713"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1038\/s41581-021-00430-6","article-title":"Hypertension-Induced Cognitive Impairment: From Pathophysiology to Public Health","volume":"17","author":"Ungvari","year":"2021","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1177\/0271678X241296799","article-title":"Impact of Intracranial Hypertension and Cerebral Perfusion Pressure on Spreading Depolarization","volume":"45","author":"Nishimoto","year":"2025","journal-title":"J. Cereb. Blood Flow. Metab. Off. J. Int. Soc. Cereb. Blood Flow. Metab."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Taha, B., McGovern, R., and Lam, C. (2025). A Synthesized View of the CSF-Blood Barrier and Its Surgical Implications for Aging Disorders. Front. Aging Neurosci., 16.","DOI":"10.3389\/fnagi.2024.1492449"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zedde, M., and Pascarella, R. (2025). Leptomeninges: Anatomy, Mechanisms of Disease and Neuroimaging. Neurol. Int., 17.","DOI":"10.3390\/neurolint17120203"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Bala, A., Olejnik, A., Rejner, W., Gottman-Naro\u017cna, A., Koczyk, K., Dziedzic, T., and Kunert, P. (2025). Executive Dysfunctions in Patients with Low-Grade Gliomas in the Supplementary Motor Area: A Neuropsychological Perspective. Front. Hum. Neurosci., 19.","DOI":"10.3389\/fnhum.2025.1554063"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1007\/s00234-021-02691-1","article-title":"Radiohistogenomics of Pediatric Low-Grade Neuroepithelial Tumors","volume":"63","author":"Bag","year":"2021","journal-title":"Neuroradiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1038\/s41392-025-02299-4","article-title":"Glioblastoma at the Crossroads: Current Understanding and Future Therapeutic Horizons","volume":"10","author":"Singh","year":"2025","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100525","DOI":"10.1016\/j.wnsx.2025.100525","article-title":"Managing Neurosurgical Complications in Emergency Settings: An Evidence-Based Review of Challenges and Strategies","volume":"28","author":"Mansour","year":"2025","journal-title":"World Neurosurg. X"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Bonosi, L., Marrone, S., Benigno, U.E., Buscemi, F., Musso, S., Porzio, M., Silven, M.P., Torregrossa, F., and Grasso, G. (2023). Maximal Safe Resection in Glioblastoma Surgery: A Systematic Review of Advanced Intraoperative Image-Guided Techniques. Brain Sci., 13.","DOI":"10.3390\/brainsci13020216"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bhargav, A.G., Domino, J.S., Chamoun, R., and Thomas, S.M. (2022). Mechanical Properties in the Glioma Microenvironment: Emerging Insights and Theranostic Opportunities. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.805628"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Onorini, N., Spennato, P., Orlando, V., Savoia, F., Cal\u00ec, C., Russo, C., De Martino, L., de Santi, M.S., Mirone, G., and Ruggiero, C. (2022). The Clinical and Prognostic Impact of the Choice of Surgical Approach to Fourth Ventricular Tumors in a Single-Center, Single-Surgeon Cohort of 92 Consecutive Pediatric Patients. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.821738"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Dadario, N.B., Brahimaj, B., Yeung, J., and Sughrue, M.E. (2021). Reducing the Cognitive Footprint of Brain Tumor Surgery. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.711646"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2857","DOI":"10.1038\/s41598-025-87079-4","article-title":"Diagnostic Impact of DNA Methylation Classification in Adult and Pediatric CNS Tumors","volume":"15","author":"Lebrun","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1038\/nature26000","article-title":"DNA Methylation-Based Classification of Central Nervous System Tumours","volume":"555","author":"Capper","year":"2018","journal-title":"Nature"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.canlet.2020.10.050","article-title":"Clinical Practice Guidelines for the Management of Adult Diffuse Gliomas","volume":"499","author":"Jiang","year":"2021","journal-title":"Cancer Lett."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Du, P., Yang, X., Shen, L., Chen, J., Liu, X., Wu, X., Cao, A., and Geng, D. (2023). Nomogram Model for Predicting the Prognosis of High-Grade Glioma in Adults Receiving Standard Treatment: A Retrospective Cohort Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010196"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"13412","DOI":"10.1038\/s41598-022-17707-w","article-title":"Improving MGMT Methylation Status Prediction of Glioblastoma through Optimizing Radiomics Features Using Genetic Algorithm-Based Machine Learning Approach","volume":"12","author":"Do","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s11060-021-03898-1","article-title":"Thalamic Gliomas in Adults: A Systematic Review of Clinical Characteristics, Treatment Strategies, and Survival Outcomes","volume":"155","author":"Palmisciano","year":"2021","journal-title":"J. Neurooncol."},{"key":"ref_26","first-page":"1633","article-title":"The Effect of Subthalamic Nucleus Deep Brain Stimulation and Dopaminergic Treatment on Dual-Task Manual Dexterity in Parkinson\u2019s Disease","volume":"44","year":"2023","journal-title":"Neurol. Sci. Off. J. Ital. Neurol. Soc. Ital. Soc. Clin. Neurophysiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Elzieny, A.A., Pace-Soler, E., Thomas, A.K., and Setty, B.N. (Pediatr. Radiol., 2025). Pediatric Hydrocephalus and Imaging Evaluation of Ventriculomegaly in the Emergency Setting, Pediatr. Radiol., Online ahead of print.","DOI":"10.1007\/s00247-025-06397-x"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lee, H.-S., Cho, K.-R., Park, K., and Jeon, C. (2023). Management of Cerebrospinal Fluid Leakage after Microvascular Decompression Surgery: Clinical Strategy. Life, 13.","DOI":"10.3390\/life13081771"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Rashid, K.A., Ramli, N., Ibrahim, K., Narayanan, V., and Wong, J.H.D. (2025). Lipid Biomarkers in Glioma: Unveiling Molecular Heterogeneity Through Tissue and Plasma Profiling. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26199820"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kara, F., Neyal, N., Kamykowski, M.G., Schwarz, C.G., Kendall-Thomas, J., Morrison, H.A., Senjem, M.L., Przybelski, S.A., Fought, A.J., and Port, J.D. (2025). Decoding Thalamic Glial Interplay in Multiple Sclerosis Through Proton Magnetic Resonance Spectroscopy and Positron Emission Tomography. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26178656"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Otsuji, R., Fujioka, Y., Hata, N., Kuga, D., Hatae, R., Sangatsuda, Y., Nakamizo, A., Mizoguchi, M., and Yoshimoto, K. (2024). Liquid Biopsy for Glioma Using Cell-Free DNA in Cerebrospinal Fluid. Cancers, 16.","DOI":"10.3390\/cancers16051009"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s00401-024-02800-3","article-title":"Integrated Analyses Reveal Two Molecularly and Clinically Distinct Subtypes of H3 K27M-Mutant Diffuse Midline Gliomas with Prognostic Significance","volume":"148","author":"Stegat","year":"2024","journal-title":"Acta Neuropathol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s00508-024-02460-z","article-title":"Surgical and Oncological Outcome after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma","volume":"137","author":"Bergmann","year":"2025","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1200\/JCO.23.01134","article-title":"ONC201 (Dordaviprone) in Recurrent H3 K27M-Mutant Diffuse Midline Glioma","volume":"42","author":"Gardner","year":"2024","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/6\/836\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T15:20:45Z","timestamp":1773328845000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/6\/836"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["diagnostics16060836"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16060836","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]}}}