Subependymal giant cell astrocytoma surgery: Difference between revisions
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*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. | *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 of brain|fornix]], [[hypothalamus]], [[basal ganglia]], and [[genu of internal capsule]]) and resection is associated with higher surgical morbidity and mortality. | *However, when diagnosed at a later stage, the tumor more often affects and invades neighboring structures ([[fornix of brain|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 [[Mammalian target of rapamycin|mTOR]]i-induced tumor shrinkage, many centers still strictly advocate surgical treatment, whereas others prefer medical therapy.<ref name="RothRoach2013">{{cite journal|last1=Roth|first1=Jonathan|last2=Roach|first2=E. Steve|last3=Bartels|first3=Ute|last4=Jóźwiak|first4=Sergiusz|last5=Koenig|first5=Mary Kay|last6=Weiner|first6=Howard L.|last7=Franz|first7=David N.|last8=Wang|first8=Henry Z.|title=Subependymal Giant Cell Astrocytoma: Diagnosis, Screening, and Treatment. Recommendations From the International Tuberous Sclerosis Complex Consensus Conference 2012|journal=Pediatric Neurology|volume=49|issue=6|year=2013|pages=439–444|issn=08878994|doi=10.1016/j.pediatrneurol.2013.08.017}}</ref> | |||
*Indications of surgery in subependymal giant cell astrocytoma include:<ref name="pmid21465222">{{cite journal| author=Campen CJ, Porter BE| title=Subependymal Giant Cell Astrocytoma (SEGA) Treatment Update. | journal=Curr Treat Options Neurol | year= 2011 | volume= 13 | issue= 4 | pages= 380-5 | pmid=21465222 | doi=10.1007/s11940-011-0123-z | pmc=PMC3130084 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21465222 }} </ref> | *Indications of surgery in subependymal giant cell astrocytoma include:<ref name="pmid21465222">{{cite journal| author=Campen CJ, Porter BE| title=Subependymal Giant Cell Astrocytoma (SEGA) Treatment Update. | journal=Curr Treat Options Neurol | year= 2011 | volume= 13 | issue= 4 | pages= 380-5 | pmid=21465222 | doi=10.1007/s11940-011-0123-z | pmc=PMC3130084 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21465222 }} </ref> | ||
:*[[hydrocephalus|Acute hydrocephalus]] | :*[[hydrocephalus|Acute hydrocephalus]] | ||
Revision as of 23:15, 5 November 2015
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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
- 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]
Reference
- ↑ 1.0 1.1 1.2 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.