title: Subependymal giant-cell astrocytomas in pediatric tuberous sclerosis disease: when should we operate?
abstract: OBJECTIVE
  A small percentage of tuberous sclerosis patients will develop a subependymal giant-cell astrocytoma. Given the morbidity and mortality when such a lesion is left undiagnosed, successive follow-up imaging in pediatric patients has been recommended. Surgical removal of the lesion has become the procedure of choice; however, the timing of this surgery is still a controversial subject. By analyzing our own series of data, as well as other published series, we have attempted to reach a consensus on the benefits of early versus late surgery.
  
  
  METHODS
  We retrospectively reviewed 19 patients treated surgically for intraventricular tumors in Foch Hospital and at the Fondation Adolphe de Rothschild in Paris, France, and we analyzed published pediatric reports from 1980 to 2006.
  
  
  RESULTS
  The results from our own population, as well as from other published pediatric series (15 series), indicate that subependymal giant-cell astrocytomas have a good prognosis when a macroscopically total resection has been performed. In our series, residual lesions tended to enlarge, but residual tumors remaining stable have been reported. Careful follow-up examination should be undertaken because late recurrences do occur. Larger or symptomatic lesions tend to have a higher morbidity.
  
  
  CONCLUSIONS
  We think that any lesion fulfilling the criteria for a subependymal giant-cell astrocytoma as previously described in the literature (lesion around the foramen of Monro, greater than 5 mm, with incomplete calcifications) should be removed as soon as clear evidence of growth has been confirmed.
authors.affiliation: Division of Pediatric Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: de Ribaupierre
authors.forename: Georg
authors.initials: G
authors.lastname: Dorfmüller
authors.forename: Christine
authors.initials: C
authors.lastname: Bulteau
authors.forename: Martine
authors.initials: M
authors.lastname: Fohlen
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Pinard
authors.forename: Catherine
authors.initials: C
authors.lastname: Chiron
authors.forename: Olivier
authors.initials: O
authors.lastname: Delalande
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D014402:Tuberous Sclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*