title: The outcome of surgical management of subependymal giant cell astrocytoma in tuberous sclerosis complex.
abstract: OBJECTIVE
  The indications for surgery and outcomes of patients who underwent surgical removal of subependymal giant cell astrocytomas (SEGAs) in our institution between 2000 and 2011 were reviewed.
  
  
  METHODS
  We reviewed the clinical details of 16 patients with a diagnosis of Tuberous Sclerosis Complex (TSC) who underwent surgery for SEGA in Bristol since 2000. We collected information on age, sex, epilepsy history and cognitive status. We reviewed the indications for surgery, age at surgery, surgical approach, and the size and location of the lesions. We analysed mortality, completeness of tumour resection, intraoperative blood transfusion, shunt placements, and surgical complications.
  
  
  RESULTS
  13 patients had surgery due to hydrocephalus. Increasing size of SEGA without hydrocephalus was an indication for surgery in two patients, and in one patient, the SEGA was removed because of its size and location at initial scan. 13 patients had complete tumour resection. One patient had tumour recurrence. Hydrocephalus failed to resolve or reoccurred in four patients post operatively necessitating shunt insertion. The surgical approach was transcortical in 14 patients and transcallosal in two. There was zero mortality in this series. There were no reports of cognitive decline or worsening epilepsy following surgery.
  
  
  CONCLUSIONS
  Surgery is a safe and effective treatment for SEGA. It is the authors' view that surgery remains the most appropriate treatment strategy for SEGAs that are amenable to surgery. More work needs to be undertaken to assess prospectively the neurocognitive impact of surgery, and the relative advantages of different surgical approaches.
authors.affiliation: Paediatric Neurology, University of Bristol, Bristol, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Amin
authors.forename: Michael
authors.initials: M
authors.lastname: Carter
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Edwards
authors.forename: Ian
authors.initials: I
authors.lastname: Pople
authors.forename: Kristian
authors.initials: K
authors.lastname: Aquilina
authors.forename: Jane
authors.initials: J
authors.lastname: Merrifield
authors.forename: John P
authors.initials: JP
authors.lastname: Osborne
authors.forename: Finbar J K
authors.initials: FJ
authors.lastname: O'Callaghan
mesh_terms: D000293:Adolescent; D000328:Adult; D001254:Astrocytoma / Q000209:etiology / Q000601:surgery*; D001932:Brain Neoplasms / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D014402:Tuberous Sclerosis / Q000150:complications*; D055815:Young Adult