Subependymal giant cell astrocytoma surgery: Difference between revisions
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Revision as of 17:02, 27 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Surgery is the mainstay of treatment for subependymal giant cell astrocytoma. Gamma knife radiosurgery has also been used to treat subependymal giant cell astrocytoma.[1]
Surgery
- Surgery is the mainstay of treatment for subependymal giant cell astrocytoma.[1]
- Treatment of subependymal giant cell astrocytoma has been solely surgical because of a lack of responsiveness to other strategies such as chemotherapy or radiation. The latter may also be associated with an increased risk of secondary malignancies.[2]
- Generally, it is agreed that small tumors are usually less invasive and that resecting noninvasive small tumors, diagnosed while still asymptomatic, is associated with excellent clinical outcomes with low morbidity and mortality.
- However, when diagnosed at a later stage, the tumor more often affects and invades neighboring structures (fornix, hypothalamus, basal ganglia, and genu of internal capsule) and resection is associated with higher surgical morbidity and mortality.
- The choice of treatment in subependymal giant cell astrocytoma still is dependent on the experience of the individual physician. Despite the growing evidence on mTORi-induced tumor shrinkage, many centers still strictly advocate surgical treatment, whereas others prefer medical therapy.[2]
- Indications of surgery in subependymal giant cell astrocytoma include:[1]
- Acute hydrocephalus
- Worsened seizure burden
- Significant interval growth on serial neuroimaging
- Complications of surgery in subependymal giant cell astrocytoma include:[1]
Gamma Knife Radiosurgery
- Gamma knife radiosurgery has been used to treat subependymal giant cell astrocytoma.[1]
- The gamma knife surgery may significantly decrease the volume (70-80%) of subependymal giant cell astrocytoma at 6 months of treatment.[3]
- Contraindication to gamma knife radiosurgery include large tumors producing significant hydrocephalus.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Campen CJ, Porter BE (2011). "Subependymal Giant Cell Astrocytoma (SEGA) Treatment Update". Curr Treat Options Neurol. 13 (4): 380–5. doi:10.1007/s11940-011-0123-z. PMC 3130084. PMID 21465222.
- ↑ 2.0 2.1 Roth, Jonathan; Roach, E. Steve; Bartels, Ute; Jóźwiak, Sergiusz; Koenig, Mary Kay; Weiner, Howard L.; Franz, David N.; Wang, Henry Z. (2013). "Subependymal Giant Cell Astrocytoma: Diagnosis, Screening, and Treatment. Recommendations From the International Tuberous Sclerosis Complex Consensus Conference 2012". Pediatric Neurology. 49 (6): 439–444. doi:10.1016/j.pediatrneurol.2013.08.017. ISSN 0887-8994.
- ↑ Ouyang, Taohui; Zhang, Na; Benjamin, Thomas; Wang, Long; Jiao, Jiantong; Zhao, Yiqing; Chen, Jian (2014). "Subependymal giant cell astrocytoma: current concepts, management, and future directions". Child's Nervous System. 30 (4): 561–570. doi:10.1007/s00381-014-2383-x. ISSN 0256-7040.