Top

Published in:

Open Access 01-12-2021 | Astrocytoma | Research article

Experience using mTOR inhibitors for subependymal giant cell astrocytoma in tuberous sclerosis complex at a single facility

Authors: Kyoichi Tomoto, Ayataka Fujimoto, Chikanori Inenaga, Tohru Okanishi, Shin Imai, Masaaki Ogai, Akiko Fukunaga, Hidenori Nakamura, Keishiro Sato, Akira Obana, Takayuki Masui, Yoshifumi Arai, Hideo Enoki

Published in: BMC Neurology | Issue 1/2021

Abstract

Background

Subependymal giant cell astrocytoma (SEGA) is occasionally seen in tuberous sclerosis complex (TSC). Two main options are currently available for treating SEGA: surgical resection or pharmacotherapy using mammalian target of rapamycin inhibitors (mTORi). We hypothesized that opportunities for surgical resection of SEGA would have reduced with the advent of mTORi.

Methods

We retrospectively reviewed the charts of patients treated between August 1979 and July 2020, divided into a pre-mTORi era group (Pre-group) of patients treated before November 2012, and a post-mTORi era group (Post-group) comprising patients treated from November 2012, when mTORi became available in Japan for SEGA. We compared groups in terms of treatment with surgery or mTORi. We also reviewed SEGA size, rate of acute hydrocephalus, recurrence of SEGA, malignant transformation and adverse effects of mTORi.

Results

In total, 120 patients with TSC visited our facility, including 24 patients with SEGA. Surgical resection was significantly more frequent in the Pre-group (6 of 7 patients, 86 %) than in the Post-group (2 of 17 patients, 12 %; p = 0.001). Acute hydrocephalus was seen in 1 patient (4 %), and no patients showed malignant transformation of SEGA. The group treated using mTORi showed significantly smaller SEGA compared with the group treated under a wait-and-see policy (p = 0.012). Adverse effects of pharmacotherapy were identified in seven (64 %; 6 oral ulcers, 1 irregular menstruation) of the 11 patients receiving mTORi.

Conclusions

The Post-group underwent surgery significantly less often than the Pre-group. Since the treatment option to use mTORi in the treatment of SEGA in TSC became available, opportunities for surgical resection have decreased in our facility.

Russo C, Nastro A, Cicala D, De Liso M, Covelli EM, Cinalli G. Neuroimaging in tuberous sclerosis complex. Childs Nerv Syst. 2020. https://doi.org/10.1007/s00381-020-04705-4.CrossRefPubMed

Wataya-Kaneda M, Tanaka M, Hamasaki T, Katayama I. Trends in the prevalence of tuberous sclerosis complex manifestations: an epidemiological study of 166 Japanese patients. PloS one. 2013;8:e63910. https://doi.org/10.1371/journal.pone.0063910.CrossRefPubMedPubMedCentral

Fujimoto A, Okanishi T, Imai S, Ogai M, Fukunaga A, Nakamura H, Sato K, Obana A, Masui T, Arai Y, Enoki H. Establishment of a regional interdisciplinary medical system for managing patients with tuberous sclerosis complex (TSC). Sci Rep. 2018;8:16747. https://doi.org/10.1038/s41598-018-35168-y.CrossRefPubMedPubMedCentral

Jansen AC, Belousova E, Benedik MP, Carter T, Cottin V, Curatolo P, D’Amato L, Beaure d’Augères G, de Vries PJ, Ferreira JC, Feucht M, Fladrowski C, Hertzberg C, Jozwiak S, Lawson JA, Macaya A, Marques R, Nabbout R, O’Callaghan F, Qin J, Sander V, Sauter M, Shah S, Takahashi Y, Touraine R, Youroukos S, Zonnenberg B, Kingswood JC. Newly diagnosed and growing subependymal giant cell astrocytoma in adults with tuberous sclerosis complex: results from the international TOSCA study. Front Neurol. 2019;10:821. https://doi.org/10.3389/fneur.2019.00821.CrossRefPubMedPubMedCentral

Jansen AC, Belousova E, Benedik MP, Carter T, Cottin V, Curatolo P, Dahlin M, D’Amato L, d’Augères GB, de Vries PJ, Ferreira JC, Feucht M, Fladrowski C, Hertzberg C, Jozwiak S, Lawson JA, Macaya A, Marques R, Nabbout R, O’Callaghan F, Qin J, Sander V, Sauter M, Shah S, Takahashi Y, Touraine R, Youroukos S, Zonnenberg B, Kingswood JC. Clinical characteristics of subependymal giant cell astrocytoma in tuberous sclerosis complex. Front Neurol. 2019;10:705. https://doi.org/10.3389/fneur.2019.00705.CrossRefPubMedPubMedCentral

Curatolo P, Bjørnvold M, Dill PE, Ferreira JC, Feucht M, Hertzberg C, Jansen A, Jóźwiak S, Kingswood JC, Kotulska K, Macaya A, Moavero R, Nabbout R, Zonnenberg BA. The role of mTOR inhibitors in the treatment of patients with tuberous sclerosis complex: evidence-based and expert opinions. Drugs. 2016;76:551–65. https://doi.org/10.1007/s40265-016-0552-9.CrossRefPubMed

Franz DN, Belousova E, Sparagana S, Bebin EM, Frost M, Kuperman R, Witt O, Kohrman MH, Flamini JR, Wu JY, Curatolo P, de Vries PJ, Berkowitz N, Anak O, Niolat J, Jozwiak S. Everolimus for subependymal giant cell astrocytoma in patients with tuberous sclerosis complex: 2-year open-label extension of the randomised EXIST-1 study. Lancet Oncol. 2014;15:1513–20. https://doi.org/10.1016/s1470-2045(14)70489-9.CrossRefPubMed

Fohlen M, Ferrand-Sorbets S, Delalande O, Dorfmüller G. Surgery for subependymal giant cell astrocytomas in children with tuberous sclerosis complex. Childs Nerv Syst. 2018;34:1511–9. https://doi.org/10.1007/s00381-018-3826-6.CrossRefPubMed

Giordano F, Moscheo C, Lenge M, Biagiotti R, Mari F, Sardi I, Buccoliero AM, Mongardi L, Aronica E, Guerrini R, Genitori L. Neurosurgical treatment of subependymal giant cell astrocytomas in tuberous sclerosis complex: a series of 44 surgical procedures in 31 patients. Childs Nerv Syst. 2020;36:951–60. https://doi.org/10.1007/s00381-019-04449-w.CrossRefPubMed

10.

Lu DS, Karas PJ, Krueger DA, Weiner HL. Central nervous system manifestations of tuberous sclerosis complex. Am J Med Genet C Semin Med Genet. 2018;178:291–8. https://doi.org/10.1002/ajmg.c.31647.CrossRefPubMed

11.

Chan DL, Calder T, Lawson JA, Mowat D, Kennedy SE. The natural history of subependymal giant cell astrocytomas in tuberous sclerosis complex: a review. Rev Neurosci. 2018;29:295–301. https://doi.org/10.1515/revneuro-2017-0027.CrossRefPubMed

12.

Ouyang T, Zhang N, Benjamin T, Wang L, Jiao J, Zhao Y, Chen J. Subependymal giant cell astrocytoma: current concepts, management, and future directions. Childs Nerv Syst. 2014;30:561–70. https://doi.org/10.1007/s00381-014-2383-x.CrossRefPubMed

13.

Desai VR, Jenson AV, Hoverson E, Desai RM, Boghani Z, Lee MR. Stereotactic laser ablation for subependymal giant cell astrocytomas: personal experience and review of the literature. Childs Nerv Syst. 2020. https://doi.org/10.1007/s00381-020-04638-y.CrossRefPubMed

14.

Feroze AH, McGrath M, Williams JR, Young CC, Ene CI, Buckley RT, Cole BL, Ojemann JG, Hauptman JS. Laser interstitial thermal therapy for pediatric atypical teratoid/rhabdoid tumor: case report. Neurosurg Focus. 2020;48:E11. https://doi.org/10.3171/2019.10.Focus19746.CrossRefPubMed

15.

Cinalli G, Imperato A, Mirone G, Di Martino G, Nicosia G, Ruggiero C, Aliberti F, Spennato P. Initial experience with endoscopic ultrasonic aspirator in purely neuroendoscopic removal of intraventricular tumors. J Neurosurg Pediatr. 2017;19:325–32. https://doi.org/10.3171/2016.10.Peds16352.CrossRefPubMed

16.

Harter DH, Bassani L, Rodgers SD, Roth J, Devinsky O, Carlson C, Wisoff JH, Weiner HL. A management strategy for intraventricular subependymal giant cell astrocytomas in tuberous sclerosis complex. J Neurosurg Pediatr. 2014;13:21–8. https://doi.org/10.3171/2013.9.Peds13193.CrossRefPubMed

17.

Hidalgo ET, Ali A, Weiner HL, Harter DH. Resection of intraventricular tumors in children by purely endoscopic means. World Neurosurg. 2016;87:372–80. https://doi.org/10.1016/j.wneu.2015.11.052.CrossRefPubMed

18.

Rodgers SD, Bassani L, Weiner HL, Harter DH. Stereotactic endoscopic resection and surgical management of a subependymal giant cell astrocytoma: case report. J Neurosurg Pediatr. 2012;9:417–20. https://doi.org/10.3171/2011.12.Peds11349.CrossRefPubMed

19.

Tawk RG, Akinduro OO, Grewal SS, Brasiliense L, Grand W, Grotenhuis A. Endoscopic transforaminal transchoroidal approach to the third ventricle for cystic and solid tumors. World Neurosurg. 2020;134:e453-9. https://doi.org/10.1016/j.wneu.2019.10.099.CrossRefPubMed

20.

Auvin S, Bissler JJ, Cottin V, Fujimoto A, Hofbauer GFL, Jansen AC, Jóźwiak S, Kerecuk L, Kingswood JC, Moavero R, Torra R, Villanueva V. A step-wise approach for establishing a multidisciplinary team for the management of tuberous sclerosis complex: a Delphi consensus report. Orphanet J Rare Dis. 2019;14:91. https://doi.org/10.1186/s13023-019-1072-y.CrossRefPubMedPubMedCentral

21.

Alsowat D, Zak M, McCoy B, Kabir N, Al-Mehmadi S, Chan V, Whitney R. A review of investigations for patients with tuberous sclerosis complex who were referred to the tuberous sclerosis clinic at the hospital for sick children: identifying gaps in surveillance. Pediatr Neurol. 2020;102:44–8. https://doi.org/10.1016/j.pediatrneurol.2019.06.018.CrossRefPubMed

22.

Franz DN, Belousova E, Sparagana S, Bebin EM, Frost MD, Kuperman R, Witt O, Kohrman MH, Flamini JR, Wu JY, Curatolo P, de Vries PJ, Berkowitz N, Niolat J, Jóźwiak S. Long-term use of everolimus in patients with tuberous sclerosis complex: final results from the EXIST-1 study. PloS one. 2016;11:e0158476. https://doi.org/10.1371/journal.pone.0158476.CrossRefPubMedPubMedCentral

23.

Kingswood JC, Jozwiak S, Belousova ED, Frost MD, Kuperman RA, Bebin EM, Korf BR, Flamini JR, Kohrman MH, Sparagana SP, Wu JY, Brechenmacher T, Stein K, Berkowitz N, Bissler JJ, Franz DN. The effect of everolimus on renal angiomyolipoma in patients with tuberous sclerosis complex being treated for subependymal giant cell astrocytoma: subgroup results from the randomized, placebo-controlled, Phase 3 trial EXIST-1. Nephrol Dial Transplant. 2014;29:1203–10. https://doi.org/10.1093/ndt/gfu013.CrossRefPubMedPubMedCentral

24.

Franz DN, Lawson JA, Yapici Z, Ikeda H, Polster T, Nabbout R, Curatolo P, de Vries PJ, Dlugos DJ, Voi M, Fan J, Vaury A, Pelov D, French JA. Everolimus for treatment-refractory seizures in TSC: Extension of a randomized controlled trial. Neurol Clin Pract. 2018;8:412–20. https://doi.org/10.1212/cpj.0000000000000514.CrossRefPubMedPubMedCentral

25.

Krueger DA. Management of CNS-related disease manifestations in patients with tuberous sclerosis complex. Curr Treat Options Neurol. 2013;15:618–33. https://doi.org/10.1007/s11940-013-0249-2.CrossRefPubMed

26.

Taveira-DaSilva AM, Moss J. Management of lymphangioleiomyomatosis. F1000 Prime Rep. 2014;6:116. https://doi.org/10.12703/p6-116.CrossRef

27.

Chebib N, Archer F, Bobet-Erny A, Leroux C, Cottin V. Dysregulation of the endothelin pathway in lymphangioleiomyomatosis with no direct effect on cell proliferation and migration. Sci Rep. 2018;8:14698. https://doi.org/10.1038/s41598-018-32795-3.CrossRefPubMedPubMedCentral

28.

Krueger DA, Capal JK, Curatolo P, Devinsky O, Ess K, Tzadok M, Koenig MK, Narayanan V, Ramos F, Jozwiak S, de Vries P, Jansen AC, Wong M, Mowat D, Lawson J, Bruns S, Franz DN. Short-term safety of mTOR inhibitors in infants and very young children with tuberous sclerosis complex (TSC): Multicentre clinical experience. Eur J Paediatr Neurol. 2018;22:1066–73. https://doi.org/10.1016/j.ejpn.2018.06.007.CrossRefPubMed

29.

Weidman DR, Palasamudram S, Zak M, Whitney R, McCoy B, Bouffet E, Taylor M, Shroff M, Bartels U. The effect of mTOR inhibition on obstructive hydrocephalus in patients with tuberous sclerosis complex (TSC) related subependymal giant cell astrocytoma (SEGA). J Neurooncol. 2020;147:731–6. https://doi.org/10.1007/s11060-020-03487-8.CrossRefPubMed

30.

Roach ES, Gomez MR, Northrup H. Tuberous sclerosis complex consensus conference: revised clinical diagnostic criteria. J Child Neurol. 1998;13:624–8. https://doi.org/10.1177/088307389801301206.CrossRefPubMed

31.

Northrup H, Krueger DA, Northrup H, Krueger DA, Roberds S, Smith K, Sampson J, Korf B, Kwiatkowski DJ, Mowat D, Nellist M, Northrup H, Povey S, de Vries P, Byars A, Dunn D, Ess K, Hook D, Jansen A, King B, Sahin M, Whittemore V, Thiele E, Bebin EM, Chugani HT, Crino P, Curatolo P, Holmes G, Nabbout R, O’Callaghan F, Wheless J, Wu J, Darling TN, Cowen EW, Gosnell E, Hebert A, Mlynarczyk G, Soltani K, Teng J, Wataya-Kaneda M, Witman PM, Kingswood C, Bissler J, Budde K, Hulbert J, Guay-Woodford L, Sampson J, Sauter M, Zonneberg B, Jóźwiak S, Bartels U, Berhouma M, Franz DN, Koenig MK, Krueger DA, Roach ES, Roth J, Wang H, Weiner H, McCormack FX, Almoosa K, Brody A, Burger C, Cottin V, Finlay G, Glass J, Henske EP, Johnson S, Kotloff R, Lynch D, Moss J, Smith K, Rhu J, Da Silva AT, Young LR, Knilans T, Hinton R, Prakash A, Romp R, Singh AD, DebRoy A, Chen P-L, Sparagana S, Frost MD. Tuberous sclerosis complex diagnostic criteria update: recommendations of the 2012 international tuberous sclerosis complex consensus conference. Pediatr Neurol. 2013;49:243–54. https://doi.org/10.1016/j.pediatrneurol.2013.08.0012013.08.001.CrossRefPubMedPubMedCentral

32.

Krueger DA, Northrup H, Northrup H, Krueger DA, Roberds S, Smith K, Sampson J, Korf B, Kwiatkowski DJ, Mowat D, Nellist M, Northrup H, Povey S, de Vries P, Byars A, Dunn D, Ess K, Hook D, Jansen A, King B, Sahin M, Whittemore V, Thiele E, Bebin EM, Chugani HT, Crino P, Curatolo P, Holmes G, Nabbout R, O’Callaghan F, Wheless J, Wu J, Darling TN, Cowen EW, Gosnell E, Hebert A, Mlynarczyk G, Soltani K, Teng J, Wataya-Kaneda M, Witman PM, Kingswood C, Bissler J, Budde K, Hulbert J, Guay-Woodford L, Sampson J, Sauter M, Zonneberg B, Jóźwiak S, Bartels U, Berhouma M, Franz DN, Koenig MK, Krueger DA, Roach ES, Roth J, Wang H, Weiner H, McCormack FX, Almoosa K, Brody A, Burger C, Cottin V, Finlay G, Glass J, Henske EP, Johnson S, Kotloff R, Lynch D, Moss J, Smith K, Rhu J, Da Silva AT, Young LR, Knilans T, Hinton R, Prakash A, Romp R, Singh AD, DebRoy A, Chen P-L, Sparagana S, Frost MD. Tuberous sclerosis complex surveillance and management: recommendations of the 2012 international tuberous sclerosis complex consensus conference. Pediatr Neurol. 2013;49:255–65. https://doi.org/10.1016/j.pediatrneurol.2013.08.0022013.08.002.CrossRefPubMedPubMedCentral

33.

Nabbout R, Santos M, Rolland Y, Delalande O, Dulac O, Chiron C. Early diagnosis of subependymal giant cell astrocytoma in children with tuberous sclerosis. J Neurol Neurosurg Psychiatry. 1999;66:370–5. https://doi.org/10.1136/jnnp.66.3.370.CrossRefPubMedPubMedCentral

34.

Roth J, Roach ES, Bartels U, Jóźwiak S, Koenig MK, Weiner HL, Franz DN, Wang HZ. Subependymal giant cell astrocytoma: diagnosis, screening, and treatment recommendations from the international tuberous sclerosis complex consensus conference 2012. Pediatr Neurol. 2013;49:439–44. https://doi.org/10.1016/j.pediatrneurol.2013.08.0172013.08.017.CrossRefPubMed

35.

Jóźwiak S, Mandera M, Młynarski W. Natural history and current treatment options for subependymal giant cell astrocytoma in tuberous sclerosis complex. Semin Pediatr Neurol. 2015;22:274–81. https://doi.org/10.1016/j.spen.2015.10.003.CrossRefPubMed

36.

Moavero R, Carai A, Mastronuzzi A, Marciano S, Graziola F, Vigevano F, Curatolo P. Everolimus alleviates obstructive hydrocephalus due to subependymal giant cell astrocytomas. Pediatr Neurol. 2017;68:59–63. https://doi.org/10.1016/j.pediatrneurol.2016.11.003.CrossRefPubMed

37.

Orešković D, Klarica M. Development of hydrocephalus and classical hypothesis of cerebrospinal fluid hydrodynamics: facts and illusions. Prog Neurobiol. 2011;94:238–58. https://doi.org/10.1016/j.pneurobio.2011.05.005.CrossRefPubMed

38.

Arroyo MS, Krueger DA, Broomall E, Stevenson CB, Franz DN. Acute management of symptomatic subependymal giant cell astrocytoma with everolimus. Pediatr Neurol. 2017. https://doi.org/10.1016/j.pediatrneurol.2017.04.008.CrossRefPubMed

39.

Fujimoto A, Matsumura A, Maruno T, Yasuda S, Yamamoto M, Nose T. Normal pressure hydrocephalus after gamma knife radiosurgery for cerebellopontine angle meningioma. J Clin Neurosci. 2004;11:785–7. https://doi.org/10.1016/j.jocn.2003.12.016.CrossRefPubMed

40.

Orešković D, Maraković J, Varda R, Radoš M, Jurjević I, Klarica M. New insight into the mechanism of mannitol effects on cerebrospinal fluid pressure decrease and craniospinal fluid redistribution. Neuroscience. 2018;392:164–71. https://doi.org/10.1016/j.neuroscience.2018.09.029.CrossRefPubMed

41.

Cuccia V, Zuccaro G, Sosa F, Monges J, Lubienieky F, Taratuto AL. Subependymal giant cell astrocytoma in children with tuberous sclerosis. Childs Nerv Syst. 2003;19:232–43. https://doi.org/10.1007/s00381-002-0700-2.CrossRefPubMed

42.

Park KJ, Kano H, Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD. Gamma Knife surgery for subependymal giant cell astrocytomas. Clinical article. J Neurosurg. 2011;114:808–13. https://doi.org/10.3171/2010.9.Jns10816.CrossRefPubMed

43.

Adriaensen ME, Schaefer-Prokop CM, Stijnen T, Duyndam DA, Zonnenberg BA, Prokop M. Prevalence of subependymal giant cell tumors in patients with tuberous sclerosis and a review of the literature. Eur J Neurol. 2009;16:691–6. https://doi.org/10.1111/j.1468-1331.2009.02567.x.CrossRefPubMed

44.

Kotulska K, Borkowska J, Mandera M, Roszkowski M, Jurkiewicz E, Grajkowska W, Bilska M, Jóźwiak S. Congenital subependymal giant cell astrocytomas in patients with tuberous sclerosis complex. Childs Nerv Syst. 2014;30:2037–42. https://doi.org/10.1007/s00381-014-2555-8.CrossRefPubMedPubMedCentral

45.

Moavero R, Romagnoli G, Graziola F, Curatolo P. Mammalian target of rapamycin inhibitors and life-threatening conditions in tuberous sclerosis complex. Semin Pediatr Neurol. 2015;22:282–94. https://doi.org/10.1016/j.spen.2015.10.006.CrossRefPubMed

46.

Sun P, Kohrman M, Liu J, Guo A, Rogerio J, Krueger D. Outcomes of resecting subependymal giant cell astrocytoma (SEGA) among patients with SEGA-related tuberous sclerosis complex: a national claims database analysis. Curr Med Res Opin. 2012;28:657–63. https://doi.org/10.1185/03007995.2012.658907.CrossRefPubMed

47.

Berhouma M, Dubourg J, Messerer M. 2012 Neurology: Letter to the editor. Re: Sun P, Kohrman M, Liu J, et al. Outcomes of resecting subependymal giant cell astrocytoma (SEGA) among patients with SEGA-related tuberous sclerosis complex: a national claims database analysis. Curr Med Res Opin. 2012;28:657–63. https://doi.org/10.1185/03007995.2012.7198652012.719865 Current medical research and opinion 28: 1571–1572; author reply 1572–1573.CrossRef

48.

Li M, Zhou Y, Chen C, Yang T, Zhou S, Chen S, Wu Y, Cui Y. Efficacy and safety of mTOR inhibitors (rapamycin and its analogues) for tuberous sclerosis complex: a meta-analysis. Orphanet J Rare Dis. 2019;14:39. https://doi.org/10.1186/s13023-019-1012-x.CrossRefPubMedPubMedCentral

49.

Jóźwiak S, Nabbout R, Curatolo P. Management of subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex (TSC): Clinical recommendations. Eur J Paediatr Neurol. 2013;17:348–52. https://doi.org/10.1016/j.ejpn.2012.12.008.CrossRefPubMed

50.

Taraszewska A, Kroh H, Majchrowski A. Subependymal giant cell astrocytoma: clinical, histologic and immunohistochemical characteristic of 3 cases. Folia Neuropathol. 1997;35:181–6.PubMed

51.

Grajkowska W, Kotulska K, Jurkiewicz E, Roszkowski M, Daszkiewicz P, Jóźwiak S, Matyja E. Subependymal giant cell astrocytomas with atypical histological features mimicking malignant gliomas. Folia Neuropathol. 2011;49:39–46.PubMed

52.

Bongaarts A, de Jong JM, Broekaart DWM, van Scheppingen J, Anink JJ, Mijnsbergen C, Jansen FE, Spliet WGM, den Dunnen WFA, Gruber VE, Scholl T, Hainfellner JA, Feucht M, Borkowska J, Kotulska K, Jozwiak S, Grajkowska W, Buccoliero AM, Caporalini C, Giordano F, Genitori L, Scicluna BP, -van SchoutenMeeteren AYN, van Vliet EA, Mühlebner A, Mills JD, Aronica E. Dysregulation of the MMP/TIMP proteolytic system in subependymal giant cell astrocytomas in patients with tuberous sclerosis complex: modulation of MMP by MicroRNA-320d in vitro. J Neuropathol Exp Neurol. 2020;79:777–90. https://doi.org/10.1093/jnen/nlaa040.CrossRefPubMedPubMedCentral

53.

Kasper E, Laviv Y, Sebai ME, Lin N, Butler W. Subependymal giant cell astrocytoma: associated hyperproteinorrhachia causing shunt failures and nonobstructive hydrocephalus - report of successful treatment with long-term follow-up. Asian J Neurosurg. 2017;12:746–50. https://doi.org/10.4103/ajns.AJNS_231_16.CrossRefPubMedPubMedCentral

54.

Laviv Y, Jackson S, Rappaport ZH. Persistent communicating hydrocephalus in adult tuberous sclerosis patients: a possible therapeutic role for everolimus. Acta Neurochir (Wien). 2015;157:241–5. https://doi.org/10.1007/s00701-014-2309-0.CrossRef

Title: Experience using mTOR inhibitors for subependymal giant cell astrocytoma in tuberous sclerosis complex at a single facility
Authors: Kyoichi Tomoto
Ayataka Fujimoto
Chikanori Inenaga
Tohru Okanishi
Shin Imai
Masaaki Ogai
Akiko Fukunaga
Hidenori Nakamura
Keishiro Sato
Akira Obana
Takayuki Masui
Yoshifumi Arai
Hideo Enoki
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Astrocytoma
Hydrocephalus
Hydrocephalus
Tuberous Sclerosis
Astrocytoma
Hydrocephalus
Astrocytoma
mTOR-Inhibitors
Published in: BMC Neurology / Issue 1/2021
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-021-02160-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Experience using mTOR inhibitors for subependymal giant cell astrocytoma in tuberous sclerosis complex at a single facility

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Effects of combining manual therapy, neck muscle exercises, and therapeutic pain neuroscience education in patients with migraine: a study protocol for a randomized clinical trial

20-hydroxyeiscosatetraenoic acid may be as a predictor of malignant middle cerebral artery infarction in patients with massive middle cerebral artery infarction

Autoimmune encephalitis with coexistent LGI1 and GABABR1 antibodies: case report

Confusion, cognitive impairment, and spinal cord compression caused by plasmacytoma: a case report

Pre-diabetes is a predictor of short-term poor outcomes after acute ischemic stroke using IV thrombolysis

Camptocormia in patients with multiple system atrophy at different disease durations: frequency and related factors