Stereotactic laser ablation for subependymal giant cell astrocytomas: personal experience and review of the literature

Purpose Subependymal giant cell astrocytomas (SEGAs) are rare tumors typically found in tuberous sclerosis patients. They typically grow in the region of the foramen of Monro and can occlude it, leading to hydrocephalus. Currently, gross total resection is the standard of care, with low rates of recurrence but high rates of complication, especially with larger lesions. Laser interstitial thermal therapy (LITT) is a newly emerging treatment modality for a variety of pathologies. Here, we present a case series of SEGAs managed via LITT and endoscopic, stereotactic septostomy. Methods A retrospective chart review was performed to identify three cases in which SEGAs were treated via LITT and septostomy. Stereotactic ablation was performed via magnetic resonance (MR) thermometry with laser output set to 69% for 2.5 min, with post-ablation scans for visualization of treatment area. Results Average age at surgery was 8.2 years. Pre-operative tumor volumes were 0.43, 1.51, and 3.88 cm(3). Post-operative tumor volumes were 0.25, 0.21, and 0.68 cm(3). Mean tumor volume reduction was 70%. No complications occurred. Conclusion LITT with septostomy should be considered a viable primary or adjunct treatment modality for SEGAs.