Trapped ventricle after laser ablation of a subependymal giant cell astrocytoma complicated by intraventricular gadolinium extravasation: case report

2018 ◽  
Vol 21 (5) ◽  
pp. 523-527 ◽  
Author(s):  
Michael Karsy ◽  
Daxa M. Patel ◽  
Robert J. Bollo
Keyword(s):  
Laser Ablation ◽  
Giant Cell ◽  
Lateral Ventricle ◽  
Obstructive Hydrocephalus ◽  
Attractive Alternative ◽  
Subependymal Giant Cell Astrocytoma ◽  
Foramen Of Monro ◽  
Delayed Complication ◽  
Effect Of Treatment ◽  
The Right

Magnetic resonance imaging–guided stereotactic laser ablation of intracranial targets, including brain tumors, has expanded dramatically over the past decade, but there have been few reports of complications, especially those occurring in a delayed fashion. Laser ablation of subependymal giant cell astrocytomas (SEGAs) is an attractive alternative to maintenance immunotherapy in some children with tuberous sclerosis complex (TSC); however, the effect of treatment on disease progression and the nature and frequency of potential complications remains largely unknown. The authors report the case of a 5-year-old boy with TSC who underwent stereotactic laser ablation of a SEGA at the right foramen of Monro on 2 separate occasions. After the second ablation, immediate posttreatment MRI revealed gadolinium extravasation from the tumor into the lateral ventricle. Nine months later, the patient presented with papilledema and delayed obstructive hydrocephalus secondary to intraventricular adhesions causing a trapped right lateral ventricle. This was successfully treated with endoscopic septostomy. The authors discuss the potential cause and clinical management of a delayed complication not previously reported after a relatively novel surgical therapy.

scholarly journals Subependymal giant cell astrocytoma with high choline/creatine ratio on proton MR spectroscopy

2006 ◽  
Vol 64 (3b) ◽  
pp. 877-880 ◽  
Author(s):  
Arnolfo de Carvalho Neto ◽  
Emerson L. Gasparetto ◽  
Isac Bruck
Keyword(s):  
Tuberous Sclerosis ◽  
Giant Cell ◽  
Mr Spectroscopy ◽  
Subependymal Giant Cell Astrocytoma ◽  
Foramen Of Monro ◽  
Proton Mr Spectroscopy ◽  
History Of ◽  
The Right ◽  
Subependymal Nodules ◽  
Giant Cell Astrocytoma

OBJECTIVE: To report a case of subependymal giant cell astrocytoma (SEGA) in a patient with tuberous sclerosis, emphasizing the proton MR spectroscopy (MRS) findings. CASE: A three year-old boy with tuberous sclerosis presented with a 3-month history of mild headache. The physical examination showed discrete mental retardation and multiple hypomelanic macules in the legs and back. MRI showed many cortical tubers and subependymal nodules. At the left foramen of Monro, there was a 15 mm nodule, with heterogeneous signal on T1 and T2-weighted images, and strong enhancement after contrast administration. MRS study (multi-voxel PRESS, TE=144ms) showed the following ratios: a) left foramen of Monro nodule N-acetylaspartate (NAA)/creatine (Cr)=0.93 and Choline (Cho)/Cr=1.6 and b) at the right Monro foramen NAA/Cr=1.56 and Cho/Cr=1.29. CONCLUSION: The MRS performed at the SEGA may show high Cho/Cr and low NAA/Cr ratios, similar to the other brain neoplasms. As a consequence, MRS may be a valuable tool for the early detection of neoplastic transformation of subependymal nodules near the foramina of Monro in patients with tuberous sclerosis.

scholarly journals Subependymal giant cell astrocytoma in the absence of tuberous sclerosis complex: case report

2015 ◽  
Vol 16 (2) ◽  
pp. 134-137 ◽  
Author(s):  
Thomas L. Beaumont ◽  
Jakub Godzik ◽  
Sonika Dahiya ◽  
Matthew D. Smyth
Keyword(s):  
Tuberous Sclerosis ◽  
Giant Cell ◽  
Clinical Features ◽  
Tuberous Sclerosis Complex ◽  
Left Ventricular ◽  
Complex Case ◽  
Subependymal Giant Cell Astrocytoma ◽  
Clinical Approach ◽  
Foramen Of Monro ◽  
Giant Cell Astrocytoma

The authors report the case of a 14-year-old male with a subependymal giant cell astrocytoma (SEGA) that occurred in the absence of tuberous sclerosis complex (TSC). The patient presented with progressive headache and the sudden onset of nausea and vomiting. Neuroimaging revealed an enhancing left ventricular mass located in the region of the foramen of Monro with significant mass effect and midline shift. The lesion had radiographic characteristics of SEGA; however, the diagnosis remained unclear given the absence of clinical features of TSC. The patient underwent gross-total resection of the tumor with resolution of his symptoms. Although tumor histology was consistent with SEGA, genetic analysis of both germline and tumor DNA revealed no TSC1/2 mutations. Similarly, a comprehensive clinical evaluation failed to reveal any clinical features characteristic of TSC. Few cases of SEGA without clinical or genetic evidence of TSC have been reported. The histogenesis, genetics, and clinical approach to this rare lesion are briefly reviewed.

scholarly journals Stereotactic laser ablation for hypothalamic and deep intraventricular lesions

2016 ◽  
Vol 41 (4) ◽  
pp. E10 ◽  
Author(s):  
Robert T. Buckley ◽  
Anthony C. Wang ◽  
John W. Miller ◽  
Edward J. Novotny ◽  
Jeffrey G. Ojemann
Keyword(s):  
Laser Ablation ◽  
Obstructive Hydrocephalus ◽  
Invasive Procedure ◽  
Mesial Temporal Lobe Epilepsy ◽  
Tumor Control ◽  
Hypothalamic Hamartoma ◽  
Subependymal Giant Cell Astrocytoma ◽  
Seizure Freedom ◽  
Long Term Follow Up ◽  
Ventricular Tumors

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.

scholarly journals Subependymal Giant-cell Astrocytoma arising from the Trigone of the Lateral Ventricle

1987 ◽  
Vol 27 (3) ◽  
pp. 202-207
Author(s):  
Takashi ANDOH ◽  
Morio KUMAGAI ◽  
Hiroaki KONDOH ◽  
Noboru SAKAI ◽  
Hiromu YAMADA ◽  
...  
Keyword(s):  
Giant Cell ◽  
Lateral Ventricle ◽  
Subependymal Giant Cell Astrocytoma ◽  
Giant Cell Astrocytoma

Stereotactic endoscopic resection and surgical management of a subependymal giant cell astrocytoma

2012 ◽  
Vol 9 (4) ◽  
pp. 417-420 ◽  
Author(s):  
Shaun D. Rodgers ◽  
Luigi Bassani ◽  
Howard L. Weiner ◽  
David H. Harter
Keyword(s):  
Giant Cell ◽  
Endoscopic Resection ◽  
Case Reports ◽  
Obstructive Hydrocephalus ◽  
Mammalian Target Of Rapamycin ◽  
Mtor Inhibitors ◽  
Benign Tumors ◽  
Subependymal Giant Cell Astrocytoma ◽  
Early Case

Subependymal giant cell astrocytomas (SEGAs) are benign tumors, most commonly associated with tuberous sclerosis complex (TSC). Arising from the lateral ependymal surface, these tumors may obstruct one or both foramina of Monro, resulting in hydrocephalus and often requiring treatment. Although interhemispheric-transcallosal and transcortical-transventricular approaches have been the standard methods for resecting these tumors, advances in neuroendoscopic techniques have expanded SEGAs as a potential target for endoscopic resection. The authors present a case of an endoscopically resected SEGA with stereotactic guidance in a 4-year-old girl with TSC. A gross-total resection of an enlarging SEGA was achieved. This represents one of the early case reports of endoscopically resected SEGAs. Although recent advances in medical treatment for SEGAs with mammalian target of rapamycin (mTOR) pathway inhibitors have shown promising initial results, the long-term safety and efficacy of mTOR inhibitors has yet to be determined. The propensity of these tumors to cause obstructive hydrocephalus requires that a surgical option remain. Neuroendoscopic approaches may allow a safe and effective technique.

scholarly journals Rigid endoscopic surgery of brainstem cavernous malformation on the cerebral aqueduct. Case report

2021 ◽  
Vol 27 (3) ◽  
pp. 54-56
Author(s):  
Orest I. Palamar ◽  
Andriy P. Huk ◽  
Dmytro S. Teslenko ◽  
Dmytro I. Okonskyi ◽  
Ruslan V. Aksyonov
Keyword(s):  
Lateral Ventricle ◽  
Obstructive Hydrocephalus ◽  
Cavernous Angioma ◽  
Anterior Horn ◽  
Cerebral Aqueduct ◽  
Cavernous Angiomas ◽  
Lateral Ventricles ◽  
Transforaminal Approach ◽  
The Right ◽  
The Brain

Cavernous angiomas (malformations) of the brain occur in 0.5% of the population. Most of them are asymptomatic, but due to their anatomical features, namely escape of blood into surrounding tissues, significant neurological symptoms can occur. The deep location of cavernous angiomas in the area of cerebral aqueduct makes surgical intervention difficult. Microsurgical approaches are the gold standard in removal of cavernous angiomas, but they are associated with certain surgical risks in the formation of the surgical corridor. Cavernous malformations in the cerebral aqueduct are a rare subtype. Due to anatomical localization and concomitant obstructive hydrocephalus ІІІ and lateral ventricles, they can be removed by endoscopic frontal transcortical transventricular approach. A 59-year-old patient was diagnosed with cavernous angioma of the brainstem (in the area of cerebral aqueduct) with hemorrhage and the formation of obstructive hydrocephalus ІІІ and lateral ventricles. The operation was performed: removal of the cavernous angioma in the area of cerebral aqueduct by endoscopic frontal transcortical transventricular approach on the right. Additionally, a triventriculocisternostomy was performed. Osteoplastic trepanation with centering at the Kocher’s point in size of 4 × 4 cm and the formation of a free bone flap was performed. The dura mater is cut in an H-shape. Approach to the anterior horn of the right lateral ventricle was performed. An intracerebral retractor was inserted into the anterior horn of the right lateral ventricle. Transforaminal approach to the tuber cinereum was performed - a triventriculocisternostomy was performed. Transforaminal approach to the cerebral aqueduct was performed and the cavernous angioma of the brainstem was removed. In the postoperative period, the patient had a slight deterioration in short-term memory, which regressed 2 weeks after surgery, an increase in oculomotor disorders, in particular persistent diplopia due to moderate paresis of the left oculomotor nerve. Three months after the operation, magnetic resonance imaging of the brain with intravenous contrast enhancement was performed. There are no signs of cavernous angioma. After the operation of frontal transcortical transventricular removal of cavernous angioma in the area of cerebral aqueduct, the compression of the latter was eliminated. Occlusive hydrocephalus regressed, the size of the ventricles decreased. Endoscopic frontal transcortical transventricular approach allows reaching the area of cerebral aqueduct in a less traumatic and minimally invasive manner. This technique is effective due to the low risk of surgical approach complications.

scholarly journals A Subependymal Giant Cell Astrocytoma in a Cat

2000 ◽  
Vol 37 (3) ◽  
pp. 275-278 ◽  
Author(s):  
S. Duniho ◽  
F. Y. Schulman ◽  
A. Morrison ◽  
H. Mena ◽  
A. Koestner
Keyword(s):  
Giant Cell ◽  
Neuron Specific Enolase ◽  
Subependymal Giant Cell Astrocytoma ◽  
Neurofilament Protein ◽  
Neoplastic Cells ◽  
S 100 ◽  
History Of ◽  
The Right ◽  
Pleomorphic Cells ◽  
Giant Cell Astrocytoma

A 6-year-old spayed female Domestic Shorthair cat presented with a 1 to 2-month history of blindness and altered behavior. At necropsy, a 1-cm-diameter, firm white mass was found arising from the subependymal region of the right lateral ventricular wall that protruded into and partially filled the lumen. Histologically, there was a well-demarcated, expansile paraventricular neoplasm composed of moderately pleomorphic cells within a richly fibrillar matrix arranged in interlacing streams and perivascular pseudorosette-like patterns. Neoplastic cells varied in morphology from small spindloid cells to larger polygonal cells with eccentric vesicular nuclei to neuronlike cells with vesicular nuclei and prominent nucleoli. The mitotic index was low. Immunohistochemically, neoplastic cells were positive for S-100 protein, glial fibrillary acidic protein, and neuron-specific enolase and negative for neurofilament protein. Ultrastructurally, the cells contained few to abundant bundles of intermediate filaments with variable numbers of mitochondria, endoplasmic reticulum, and ribosomes. These features are characteristic of subependymal giant cell astrocytoma (SEGA) in humans. To our knowledge, this is the first reported case of SEGA in domestic animals.

scholarly journals PC3 - 157 Subependymal Giant Cell Astrocytoma (SEGA) in Adults without Tuberous Sclerosis

2016 ◽  
Vol 43 (S4) ◽  
pp. S22-S22
Author(s):  
D.R. MacDonald ◽  
M.J. MacDonald ◽  
J.F. Megyesi ◽  
R.R. Hammond
Keyword(s):  
Family History ◽  
Tuberous Sclerosis ◽  
Giant Cell ◽  
Lateral Ventricle ◽  
Subependymal Giant Cell Astrocytoma ◽  
Cutaneous Manifestations ◽  
Caudate Head ◽  
Frontal Horn ◽  
History Of ◽  
Giant Cell Astrocytoma

Subependymal giant cell astrocytoma (SEGA) is typically seen in children with tuberous sclerosis (TS), who present with headaches and seizures, and characteristic clinical and cutaneous manifestations of TS. Surgical resection, CSF diversion (for hydrocephalus), radiotherapy, and chemotherapy with a mammalian target of rapamycin (mTOR) inhibitor are treatment options. SEGA can occur in adults without TS, raising diagnostic and therapeutic challenges. A 53 year old man presented with headaches and diplopia. An exophytic, enhancing mass in the left lateral ventricle was resected, confirming SEGA. There was no recurrence on MRI 13 months later. He previously had an “astrocytoma” involving the left frontal horn resected at age 19. Pathology review was SEGA. He had no clinical or cutaneous findings of TS, and no family history of TS. An identical twin was well. A 66 year old man presented with “weakness”, due to diuretic-induced hypokalemia. CT showed a hypodense mass from the right caudate head deforming the frontal horn. MRI showed an exophytic, enhancing mass from the caudate head into the frontal horn. A stereotactic biopsy confirmed SEGA. He had no clinical or cutaneous findings of TS, and negative family history. His mother had a meningioma resected at age 66. Observation is planned. These 2 adult patients had SEGA without clear clinical findings or family history of TS. SEGA should be in the differential diagnosis of tumors involving the lateral ventricle.

scholarly journals Lesions at the Foramen of Monro Causing Obstructive Hydrocephalus

2021 ◽  
Author(s):  
Ashish Chugh ◽  
Sarang Gotecha ◽  
Prashant Punia ◽  
Neelesh Kanaskar
Keyword(s):  
Choroid Plexus ◽  
Intraventricular Hemorrhage ◽  
Anterior Part ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Subependymal Giant Cell Astrocytoma ◽  
Foramen Of Monro ◽  
The Third ◽  
Giant Cell Astrocytoma

The foramen of Monro has also been referred to by the name of interventricular foramen. The structures comprising this foramen are the anterior part of the thalamus, the fornix and the choroid plexus. Vital structures surround the foramen, the damage to which can be catastrophic leading to disability either temporary or permanent. In the literature it has been shown that tumors occurring in the area of interventricular foramen are rare and usually cause hydrocephalus. The operative approach depends upon the location of the tumor which can be either in the lateral or the third ventricle. Various pathologies which can lead to foramen of Monro obstruction and obstructive hydrocephalus include colloid cyst, craniopharyngioma, subependymal giant cell astrocytoma [SEGA], Neurocysticercosis, tuberculous meningitis, pituitary macroadenoma, neurocytoma, ventriculitis, multiseptate hydrocephalus, intraventricular hemorrhage, functionally isolated ventricles, choroid plexus tumors, subependymomas and idiopathic foramen of monro stenosis. In this chapter, we will discuss the various lesions at the level of foramen of Monro causing obstructive hydrocephalus and the management and associated complications of these lesions based on their type, clinical picture and their appearance on imaging.

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