Advances in the management of subependymal giant cell astrocytoma

Beaumont, Thomas L.; Limbrick, David D.; Smyth, Matthew D.

doi:10.1007/s00381-012-1785-x

Cited by 40 publications

(41 citation statements)

References 35 publications

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“…Although these lesions are generally benign and noninfiltrative, they can be life-threatening as they arise typically near the foramen of Monro, unilaterally or bilaterally. Serial growth may result in acute or subacute obstructive hydrocephalus [56] and sudden death [57].…”

Section: Neurological Manifestationsmentioning

confidence: 99%

Tuberous sclerosis complex: the past and the future

2014

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Renal lesions represent the second most significant cause of morbidity and mortality in patients with tuberous sclerosis complex (TSC). Recent advances in the understanding of the pathophysiology of TSC have led to the exploration of new potential therapeutic targets. Clinical trials with mammalian target of rapamycin (mTOR) inhibitors have demonstrated promising results for several indications, such as renal angiomyolipoma, subependymal giant cell astrocytoma, lymphangioleiomyomatosis and facial angiofibromas. Currently, there is a scarcity of natural history data and randomized, placebo-controlled clinical trials on TSC. Recently, however, recommendations for the diagnostic criteria, surveillance, and management of TSC patients have been updated. This review focuses on these novel recommendations and highlights the need for multidisciplinary follow-up of this multi-systemic disease.

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Section: Neurological Manifestationsmentioning

confidence: 99%

Tuberous sclerosis complex: the past and the future

2014

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“…SENs positioned in the region of the Monro foramina can grow and transform into a SEGA. It has also been reported that solitary SEGAs even appear in the absence of any other TSC-related lesions [7,18] . Multiple signaling cascades are involved in the focal abnormalities of different organs due to depletion in either of the TSC1/TSC2 gene's second allele.…”

Section: Tsc Manifestation In Gliomagenesismentioning

confidence: 99%

“…The risk factors influencing the genesis of glioma include exposure to toxins such as vinyl chloride, ionizing radiation, electromagnetic radiation, infection with simian virus 40, gene [3] Ependymoma (2%-6% of glioma) [4,5] Astrocytoma (7% of primary brain tumors and 80%-85% of all gliomas) Juvenile pilocytic, pleo morphic and subependymal giant cell astrocytoma (SEGA) [4,[6][7][8][9] Cerebrum (oligodendrocytes) Monomorphous cells with round, regular nuclei with perinuclear halos. Focal calcifications, interspersed delicate capillaries, nuclear labelling for S100 and diffuse background staining for S100 and GFAP are present.…”

Section: Molecular Transformations As Driving Forces In Glial Tumorigmentioning

confidence: 99%

“…A neurosurgeon's perspective regarding surgical removal of the tumor relies upon the following four parameters: the nature of the lesion; neurological condition of the patient/Karnofsky performance status; arresting tumor growth; and arresting malignant transformation [7,61] . Various technical aids, such as neuronavigation and intraoperative MRI (iMRI), can be used to maximize the extent of resection in gliomas.…”

Section: Ct Scanmentioning

confidence: 99%

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Insights into molecular therapy of glioma: current challenges and next generation blueprint

et al. 2017

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Glioma accounts for the majority of human brain tumors. With prevailing treatment regimens, the patients have poor survival rates. In spite of current development in mainstream glioma therapy, a cure for glioma appears to be out of reach. The infiltrative nature of glioma and acquired resistance substancially restrict the therapeutic options. Better elucidation of the complicated pathobiology of glioma and proteogenomic characterization might eventually open novel avenues for the design of more sophisticated and effective combination regimens. This could be accomplished by individually tailoring progressive neuroimaging techniques, terminating DNA synthesis with prodrug-activating genes, silencing gliomagenesis genes (gene therapy), targeting miRNA oncogenic activity (miRNAmRNA interaction), combining Hedgehog-Gli/Akt inhibitors with stem cell therapy, employing tumor lysates as antigen sources for efficient depletion of tumor-specific cancer stem cells by cytotoxic T lymphocytes (dendritic cell vaccination), adoptive transfer of chimeric antigen receptor-modified T cells, and combining immune checkpoint inhibitors with conventional therapeutic modalities. Thus, the present review captures the latest trends associated with the molecular mechanisms involved in glial tumorigenesis as well as the limitations of surgery, radiation and chemotherapy. In this article we also critically discuss the next generation molecular therapeutic strategies and their mechanisms for the successful treatment of glioma.

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“…However, in incompletely resected SEGAs, up to 100% reoperation rates are noted. 1 Radiosurgery has also been used for inoperable tumors with reported long-term control rates of 67%, 17 and recent introduction of everolimus, an mTOR inhibitor, has provided new options for medical management. 13 Again, there exists a potential role for laser ablation for management of inoperable, symptomatic SEGAs, especially with its potential to reduce tumor volume and improve associated mass effect and/or CSF outlet obstruction.…”

mentioning

confidence: 99%

Stereotactic laser ablation for hypothalamic and deep intraventricular lesions

Buckley

Wang

Miller

et al. 2016

FOC

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OBJECTIVE Laser ablation is a novel, minimally invasive procedure that utilizes MRI-guided thermal energy to treat epileptogenic and other brain lesions. In addition to treatment of mesial temporal lobe epilepsy, laser ablation is increasingly being used to target deep or inoperable lesions, including hypothalamic hamartoma (HH), subependymal giant cell astrocytoma (SEGA), and exophytic intrinsic hypothalamic/third ventricular tumors. The authors reviewed their early institutional experience with these patients to characterize clinical outcomes in patients undergoing this procedure. METHODS A retrospective cohort (n = 12) of patients undergoing laser ablation at a single institution was identified, and clinical and radiographic records were reviewed. RESULTS Laser ablation was successfully performed in all patients. No permanent neurological or endocrine complications occurred; 2 (17%) patients developed acute obstructive hydrocephalus or shunt malfunction following treatment. Laser ablation of HH resulted in seizure freedom (Engel Class I) in 67%, with the remaining patients having a clinically significant reduction in seizure frequency of greater than 90% compared with preoperative baseline (Engel Class IIB). Treatment of SEGAs resulted in durable clinical and radiographic tumor control in 2 of 3 cases, with one patient receiving adjuvant everolimus and the other receiving no additional therapy. Palliative ablation of hypothalamic/third ventricular tumors resulted in partial tumor control in 1 of 3 patients. CONCLUSIONS Early experience suggests that laser ablation is a generally safe, durable, and effective treatment for patients harboring HHs. It also appears effective for local control of SEGAs, especially in combination therapy with everolimus. Its use as a palliative treatment for intrinsic hypothalamic/deep intraventricular tumors was less successful and associated with a higher risk of serious complications. Additional experience and long-term follow-up will be beneficial in further characterizing the effectiveness and risk profile of laser ablation in treating these lesions in comparison with conventional resective surgery or stereotactic radiosurgery.

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Advances in the management of subependymal giant cell astrocytoma

Cited by 40 publications

References 35 publications

Tuberous sclerosis complex: the past and the future

Tuberous sclerosis complex: the past and the future

Insights into molecular therapy of glioma: current challenges and next generation blueprint

Stereotactic laser ablation for hypothalamic and deep intraventricular lesions

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