Volume 49, Issue 6, Pages (December 2013)

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Volume 49, Issue 6, Pages 439-444 (December 2013) Subependymal Giant Cell Astrocytoma: Diagnosis, Screening, and Treatment. Recommendations From the International Tuberous Sclerosis Complex Consensus Conference 2012 Jonathan Roth, MD, E. Steve Roach, MD, Ute Bartels, MD, Sergiusz Jóźwiak, MD, Mary Kay Koenig, MD, Howard L. Weiner, MD, David N. Franz, MD, Henry Z. Wang, MD Pediatric Neurology Volume 49, Issue 6, Pages 439-444 (December 2013) DOI: 10.1016/j.pediatrneurol.2013.08.017 Copyright © 2013 The Authors Terms and Conditions

Figure 1 Two girls ([A], 9 and [B], 12 years old) with acute headaches and vomiting. On examination, both had papilledema. Brain magnetic resonance imaging shows ventricular subependymal giant cell astrocytomas with secondary hydrocephalus. Surgical resection is recommended in this situation. Pediatric Neurology 2013 49, 439-444DOI: (10.1016/j.pediatrneurol.2013.08.017) Copyright © 2013 The Authors Terms and Conditions

Figure 2 This 6-year-old girl had a growing but asymptomatic tumor. (A) Her screening magnetic resonance imaging at age 2 revealed a, subependymal giant cell astrocytoma with mild enlargement of the right lateral ventricle. (B) By age 6 years, the lesion had enlarged markedly. This is an example for which there is no clear advantage for either treatment but advantages for each treatment (surgical or medical). Pediatric Neurology 2013 49, 439-444DOI: (10.1016/j.pediatrneurol.2013.08.017) Copyright © 2013 The Authors Terms and Conditions

Figure 3 A 26-year-old man with multiple intracranial subependymal giant cell astrocytomas following bilateral shunts and partial resection of the left posterior tumor. The multiple and anatomically unfavorable lesions justify mTOR inhibitor treatment. Pediatric Neurology 2013 49, 439-444DOI: (10.1016/j.pediatrneurol.2013.08.017) Copyright © 2013 The Authors Terms and Conditions

Figure 4 This 9-year-old girl underwent subtotal resection of a right ventricular subependymal giant cell astrocytoma 4 years earlier. She was lost to follow-up until she presented with visual decline but no headaches. On examination, she had optic atrophy and was nearly blind. Brain magnetic resonance imaging showed a third ventricular tumor and a right temporal horn tumor. This is an example of a patient for whom a shunt can be placed followed by mTOR inhibitors. Pediatric Neurology 2013 49, 439-444DOI: (10.1016/j.pediatrneurol.2013.08.017) Copyright © 2013 The Authors Terms and Conditions