Stereotactic laser ablation for subependymal giant cell astrocytomas: personal experience and review of the literature
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ORIGINAL ARTICLE
Stereotactic laser ablation for subependymal giant cell astrocytomas: personal experience and review of the literature Virendra R. Desai 1,2 & Amanda V. Jenson 1,2 & Eric Hoverson 1 & Rajendra M. Desai 3 & Zain Boghani 1,2 & Mark R. Lee 1,4 Received: 11 March 2020 / Accepted: 22 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Subependymal giant cell astrocytomas (SEGAs) are rare tumors typically found in tuberous sclerosis patients. They typically grow in the region of the foramen of Monro and can occlude it, leading to hydrocephalus. Currently, gross total resection is the standard of care, with low rates of recurrence but high rates of complication, especially with larger lesions. Laser interstitial thermal therapy (LITT) is a newly emerging treatment modality for a variety of pathologies. Here, we present a case series of SEGAs managed via LITT and endoscopic, stereotactic septostomy. Methods A retrospective chart review was performed to identify three cases in which SEGAs were treated via LITT and septostomy. Stereotactic ablation was performed via magnetic resonance (MR) thermometry with laser output set to 69% for 2.5 min, with post-ablation scans for visualization of treatment area. Results Average age at surgery was 8.2 years. Pre-operative tumor volumes were 0.43, 1.51, and 3.88 cm3. Post-operative tumor volumes were 0.25, 0.21, and 0.68 cm3. Mean tumor volume reduction was 70%. No complications occurred. Conclusion LITT with septostomy should be considered a viable primary or adjunct treatment modality for SEGAs. Keywords Subependymal giant cell astrocytoma . Laser ablation . Septostomy
Abbreviations cm centimeters CSF cerebrospinal fluid FFE fast field echo FoV field of view GKS gamma knife surgery Hz hertz LITT laser interstitial thermal therapy mm millimeters
MR MRI ms mTOR SEGAs TE TR
* Virendra R. Desai [email protected]
1
Pediatric Neurosurgery, Dell Children’s Medical Center, Department of Neurosurgery, The University of Texas at Austin Dell Medical School, Austin, TX, USA
2
Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Scurlock Tower, Suite 944, 6560 Fannin Street, Houston, TX 77030, USA
3
Department of Radiology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
4
Department of Neurosurgery, The Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
Amanda V. Jenson [email protected] Eric Hoverson [email protected] Rajendra M. Desai [email protected] Zain Boghani [email protected] Mark R. Lee [email protected]
magnetic resonance magnetic resonance imaging milliseconds mammalian target of rapamycin subependymal giant cell astrocytomas echo time repetition time
Childs Nerv Syst
Introduction Subependymal giant cell astrocytoma (SEGA) is a rare tumor almost exclusively found in tuberous sclerosis patients [1]. These low-grade (WHO grade I) lesions typically develop in the first two decades o
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