title: Persistent communicating hydrocephalus in adult tuberous sclerosis patients: a possible therapeutic role for everolimus.
abstract: Subependymal giant cell tumor (SGCT) is a benign intraventricular tumor, usually located near the foramen of Monro. It is almost always associated with tuberous sclerosis complex (TSC). SGCTs may obstruct cerebrospinal fluid (CSF) pathways. Rarely, they may secrete a protein-rich exudate, causing communicating hydrocephalus. Surgery is indicated for symptomatic lesions or growing asymptomatic lesions. The operative approach to SGCT has shifted from simple shunt placement to a more aggressive approach, leading to early attempts at gross total resection. Recently, the mTOR inhibitor everolimus has been approved for treating SGCT. In this article, we present two cases of recurrent shunt malfunctions in adult TSC patients with protein-secreting SGCTs. We describe the complexity of treating such patients with an emphasis on the role mTOR inhibitors may have in their management. We also review the literature on surgical management of SGCT-related hydrocephalus.
authors.affiliation: Beilinson hospital, Rabin Medical Center, Neurosurgery Rabin Medical Center City, Petah Tiqva, Israel, 49100, yossilaviv@gmail.com.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Laviv
authors.forename: Steven
authors.initials: S
authors.lastname: Jackson
authors.forename: Zvi Harry
authors.initials: ZH
authors.lastname: Rappaport
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000150:complications / Q000188:drug therapy*; D002551:Cerebral Ventricle Neoplasms / Q000150:complications / Q000188:drug therapy*; D000068338:Everolimus; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome; D014402:Tuberous Sclerosis / Q000150:complications / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus