Subependymal giant cell astrocytoma surgery
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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, small tumors are usually less invasive and resecting them 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 is associated with higher surgical morbidity and mortality.[3]
- 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]
- The tumors that have invaded neighboring structures, those located bilaterally, and growing residual tumors are difficult to treat with gross total resection. Treatment with everolimus, an mTOR inhibitor may be favored in these cases.[3]
- Patients with tumors less than 2 cm and between 2 and 3 cm have a 0% and 46% chance of surgery-related complications respectively.[4]
- Bilateral subependymal giant cell astrocytomas are associated with a 67% chance of surgery-related complications.[4]
- Indications of surgery in subependymal giant cell astrocytoma include:[1][3]
- New set of symptoms
- Radiological evidence of tumor growth
- Acute hydrocephalus
- Worsened seizure burden
- Transient memory impairment
- Hemiparesis
- Infection
- Chronic ventriculoperitoneal shunt placement
- Stroke
- Death
- Cognitive decline
- Hydrocephalus
- Hematoma
- Tumors that are not completely resected can recur, requiring a repeat of the procedure.[5]
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.[6]
- 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.
- ↑ 3.0 3.1 3.2 Jung TY, Kim YH, Jung S, Baek HJ, Lee KH (2015). "The clinical characteristics of subependymal giant cell astrocytoma: five cases". Brain Tumor Res Treat. 3 (1): 44–7. doi:10.14791/btrt.2015.3.1.44. PMC 4426277. PMID 25977907.
- ↑ 4.0 4.1 4.2 Kotulska K, Borkowska J, Roszkowski M, Mandera M, Daszkiewicz P, Drabik K; et al. (2014). "Surgical treatment of subependymal giant cell astrocytoma in tuberous sclerosis complex patients". Pediatr Neurol. 50 (4): 307–12. doi:10.1016/j.pediatrneurol.2013.12.004. PMID 24507694.
- ↑ Krueger, Darcy A.; Care, Marguerite M.; Holland, Katherine; Agricola, Karen; Tudor, Cynthia; Mangeshkar, Prajakta; Wilson, Kimberly A.; Byars, Anna; Sahmoud, Tarek; Franz, David Neal (2010). "Everolimus for Subependymal Giant-Cell Astrocytomas in Tuberous Sclerosis". New England Journal of Medicine. 363 (19): 1801–1811. doi:10.1056/NEJMoa1001671. ISSN 0028-4793.
- ↑ 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.