Pediatric temporal low-grade glial tumors: epilepsy outcome following resection in 48 children

Purpose

This paper summarizes our experience with surgical treatment of pediatric low-grade glial temporal lobe tumors focusing on the long-term outcome of seizures and identifying factors associated with seizure control and failure.

Methods

We reviewed all medical records of pediatric patients that underwent temporal lobe surgery due to seizures at our institution between 1997 and 2009. Only patients with temporal lobe tumors were included in this series. The files were retrospectively reviewed for seizure history. All children had undergone pre- and postoperative evaluation, neurological examination, EEG, and MRI.

Results

The cohort includes 48 children with mean follow-up time of 5.15?years (1?C12?years). The mean age at surgery was 8.2?years (1?C18.1) and the mean seizure duration until surgery was 2.6?years. All lesions in the cohort were low-grade tumors; pilocytic astrocytoma was the most common (41%). Eighty-three percent of the patients were classified as Engel class I following surgery. There was no correlation between Engel score and the preoperative epilepsy duration, age of seizure onset or type of seizures, and pathology. The surgical complication rate was 4.1% (2/48).

Conclusions

Surgical treatment for seizure control in children and adolescents with low-grade temporal tumors provides excellent long-term results.     

Modified bilateral subtemporal decompression for resistant slit ventricle syndrome

Purpose  

Slit ventricle syndrome (SVS) remains a major problem for early shunted children. Several conservative and surgical treatment paradigms have been suggested; however, there is no consensus on the optimal surgical treatment. We present our experience using bilateral subtemporal decompressions with dura and arachnoid opening for the treatment of a subgroup of children with severe and resistant SVS.     

Placement of Ommaya reservoir following endoscopic third ventriculostomy in pediatric hydrocephalic patients: a critical reappraisal

Purpose  

Endoscopic third ventriculostomy (ETV) has become standard for obstructive hydrocephalus. Even a successful ETV can obstruct, leading to recurrence of symptoms and even death. A possible solution to this problem is leaving an Ommaya reservoir (OR) following the ETV. OR can be tapped in an emergency and for diagnostic purposes. No specific complications have been attributed to OR in this setting. We present our experience with OR in children undergoing ETV for hydrocephalus.     

Regression of subependymal giant cell astrocytomas with RAD001 (Everolimus) in tuberous sclerosis complex

Background  

Tuberous sclerosis complex (TSC) is a genetic disorder caused by inactivating mutations in the TSC1 or TSC2 genes and characterized by slow-growing tumors in multiple organs. Of the affected individuals, 10% display subependymal giant cell astrocytomas (SEGAs), which can lead to substantial neurological morbidity. The TSC1/TSC2 protein complex is a negative regulator of the mTOR pathway. Hence, mutations in these genes in preclinical models are associated with increased mTOR pathway activation and heightened sensitivity to mTOR inhibitors. We hereby report our experience with RAD001 (Everolimus) therapy, a novel mTOR inhibitor, in inducing a dramatic regression of SEGAs.     

Continuous spinal drain following endoscopic third ventriculostomy: a proposal to change the definition of failure

Purpose  

This study evaluates the safety, efficacy, and indications for continuous lumbar drainage (CLD) in patients following endoscopic third ventriculostomy (ETV).