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Nakamura H, Izumi M, Omori Y, Numoto S, Fujimoto A. Complex Factors in Hydrocephalus Development in Tuberous Sclerosis Complex: A Case Report of Subependymal Giant Cell Astrocytoma. Cureus 2024; 16:e65132. [PMID: 39040610 PMCID: PMC11262810 DOI: 10.7759/cureus.65132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2024] [Indexed: 07/24/2024] Open
Abstract
Subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex (TSC) occurs in 5-20% of TSC patients, with a subset developing hydrocephalus. We present a case of a 14-year-old male diagnosed with TSC in the neonatal period who developed SEGA and subsequent hydrocephalus. Despite reducing the tumor size with the mammalian target of rapamycin (mTOR) inhibitors, ventricular enlargement persisted, indicating that obstructive hydrocephalus due to the foramen of Monro blockage was not the sole mechanism. Elevated cerebrospinal fluid (CSF) protein levels suggested additional factors like impaired CSF outflow. This case underscores the need for comprehensive treatment strategies and further research to better understand and manage hydrocephalus in TSC patients with SEGA.
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Affiliation(s)
- Hajime Nakamura
- Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, JPN
| | - Masaki Izumi
- Center of Epilepsy and Functional Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, JPN
| | - Yoshinori Omori
- Center of Epilepsy and Functional Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, JPN
| | - Shingo Numoto
- Pediatric Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, JPN
| | - Ayataka Fujimoto
- Center of Epilepsy and Functional Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, JPN
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Goncalves FG, Mahecha-Carvajal ME, Desa A, Yildiz H, Talbeya JK, Moreno LA, Viaene AN, Vossough A. Imaging of supratentorial intraventricular masses in children: a pictorial review-part 2. Neuroradiology 2024; 66:699-716. [PMID: 38085360 PMCID: PMC11031612 DOI: 10.1007/s00234-023-03253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/13/2023] [Indexed: 12/22/2023]
Abstract
PURPOSE This article is the second in a two-part series aimed at exploring the spectrum of supratentorial intraventricular masses in children. In particular, this part delves into masses originating from cells of the ventricular lining, those within the septum pellucidum, and brain parenchyma cells extending into the ventricles. The aim of this series is to offer a comprehensive understanding of these supratentorial intraventricular masses, encompassing their primary clinical findings and histological definitions. METHODS We conducted a review and analysis of relevant epidemiological data, the current genetics/molecular classifications as per the fifth edition of the World Health Organization (WHO) Classification of Tumors of the Central Nervous System (WHO CNS5), and imaging findings. Each supratentorial intraventricular mass was individually evaluated, with a detailed discussion on its clinical and histological features. RESULTS This article covers a range of supratentorial intraventricular masses observed in children. These include colloid cysts, subependymal giant cell astrocytomas, ependymomas, gangliogliomas, myxoid glioneuronal tumors, central neurocytomas, high-grade gliomas, pilocytic astrocytomas, cavernous malformations, and other embryonal tumors. Each mass type is characterized both clinically and histologically, offering an in-depth review of their individual imaging characteristics. CONCLUSION The WHO CNS5 introduces notable changes, emphasizing the vital importance of molecular diagnostics in classifying pediatric central nervous system tumors. These foundational shifts have significant potential to impact management strategies and, as a result, the outcomes of intraventricular masses in children.
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Affiliation(s)
| | | | - Aishwary Desa
- Drexel University College of Medicine Philadelphia, Philadelphia, PA, USA
| | - Harun Yildiz
- Department of Radiology, Dortcelik Children's Hospital, Bursa, Turkey
| | | | - Luz Angela Moreno
- Pediatric Imaging, Department of Radiology, Fundación Hospital La Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Angela N Viaene
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Pathology Department, Children´s Hospital of Philadelphia, Philadelphia, USA
| | - Arastoo Vossough
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Radiology Department, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Siala S, Homen D, Smith B, Guimaraes C. Imaging of the septum pellucidum: normal, variants and pathology. Br J Radiol 2023; 96:20221058. [PMID: 37194993 PMCID: PMC10607410 DOI: 10.1259/bjr.20221058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
The septum pellucidum is a largely neglected anatomical midline structure during post-natal neuroimaging interpretation. Conversely, it is one of the anatomical landmarks used on pre-natal ultrasound to access normal midline formation. Because of its importance during the pre-natal period, the awareness of its primary malformative abnormalities is much higher than its disruptive acquired pathologies, often leading the misinterpretation. In this article, we will review the normal septum pellucidum formation, anatomy, and anatomical variants and will describe the imaging findings in primary malformative and secondary disruptive abnormalities affecting the septum pellucidum.
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Affiliation(s)
- Selima Siala
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Dean Homen
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Benjamin Smith
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Carolina Guimaraes
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina, United States
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Li K, Liang J, Niu H, Lan S, Liang X, Zhao Y, Zhao P. Effect comparison of neuroendoscopy versus microsurgery in the treatment of lateral ventricular tumors. Front Oncol 2023; 13:1008291. [PMID: 37554163 PMCID: PMC10405727 DOI: 10.3389/fonc.2023.1008291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 06/30/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE We sought to reveal the clinical characteristics of lateral ventricle tumors and to evaluate the superior surgical procedure available. METHODS There involved a total of of 49 adult patients harboring lateral ventricle tumors in neurosurgery department of our hospital from January 2016 to March 2022. The patients enrolled were retrospectively analyzed, so are their clinical manifestations, pathological characteristics and surgical strategies. The patients were allocated into neuroendoscope group (11 cases) and microsurgery group (38 cases) according to the operation method. The two groups underwent a detailed evaluation of operation effectiveness and safety profile (operation time, intraoperative bleeding, surgical resection rate, postoperative complications) and economic indicators (postoperative hospital stay, hospital costs). RESULTS The neuroendoscope group demonstrated a markedly shorter operation time than the microsurgery group (p<0.05), with the amount of bleeding significantly less than the microsurgery group (p<0.01). However, there was no significant difference in the resection rate and postoperative complications between the two groups (p>0.05). Significant difference was found in the economic indicators (postoperative hospital stay and hospital costs) of the patients in the neuroendoscope group (p<0.05). CONCLUSION Surgery intervention is regarded as the core treatment option for lateral ventricle tumors. Both microsurgery and neuroendoscopy are effective with safety profile. In the selected lateral ventricle tumor surgery, the application of neuroendoscopic surgery showed promising results, in terms of less intraoperative bleeding, and shorter operation time, postoperative hospital stays, and hospital costs. The selection of surgical approach and methods for lateral ventricle tumors is principally depended on the experience of neurosurgeon concerning the surgical approach and related neuroanatomy.
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Affiliation(s)
- Kai Li
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Jianfeng Liang
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Hongchuan Niu
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Shuang Lan
- Department of Operating Theatre, Peking University International Hospital, Beijing, China
| | - Xiaoning Liang
- Department of Neurosurgery, PKUCare Zibo Hospital, Zibo, Shandong, China
| | - Yuanli Zhao
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Zhao
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Ghani I, Patel S, Ghimire P, Bodi I, Bhangoo R, Vergani F, Ashkan K, Lavrador JP. Case report: 'Photodynamics of Subependymal Giant Cell Astrocytoma with 5-Aminolevulinic acid'. Front Surg 2023; 9:1065979. [PMID: 36684213 PMCID: PMC9853524 DOI: 10.3389/fsurg.2022.1065979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
Subependymal Giant Cell Astrocytoma (SEGA) is a common diagnosis in patients with Tuberous Sclerosis. Although surgical treatment is often required, resection may entail a significant risk for cognitive function given the anatomical relation with critical structures such as the fornices and subgenual area. Therefore, target subtotal resections using minimal invasive approaches focused in the higher metabolic areas are valuable options to preserve quality of life while addressing specific problems caused by the tumor, such as hydrocephalus or progressive growth of a specific component of the tumor. In this report, the authors explore the potential role of 5-ALA in the identification of highly metabolic areas during SEGA resection in the context of minimal invasive approaches.
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Affiliation(s)
- Imran Ghani
- King's Neuro Lab, Department of Neurosurgery, London, United Kingdom,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sabina Patel
- King's Neuro Lab, Department of Neurosurgery, London, United Kingdom,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Prajwal Ghimire
- School of Biomedical Engineering and Imaging Studies, King's College London, London, United Kingdom,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Istvan Bodi
- Department of Neuropathology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jose Pedro Lavrador
- King's Neuro Lab, Department of Neurosurgery, London, United Kingdom,Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
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De Meulemeester AS, Heylen L, Siekierska A, Mills JD, Romagnolo A, Van Der Wel NN, Aronica E, de Witte PAM. Hyperactivation of mTORC1 in a double hit mutant zebrafish model of tuberous sclerosis complex causes increased seizure susceptibility and neurodevelopmental abnormalities. Front Cell Dev Biol 2022; 10:952832. [PMID: 36238691 PMCID: PMC9552079 DOI: 10.3389/fcell.2022.952832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by pathogenic variants in TSC1 and TSC2 genes. TSC patients present with seizures and brain abnormalities such as tubers and subependymal giant cells astrocytoma (SEGA). Despite common molecular and clinical features, the severity of the disease varies greatly, even intrafamilially. The second hit hypothesis suggests that an additional, inactivating mutation in the remaining functional allele causes a more severe phenotype and therefore explains the phenotypic variability. Recently, second hit mutations have been detected frequently in mTORopathies. To investigate the pathophysiological effects of second hit mutations, several mouse models have been developed. Here, we opted for a double mutant zebrafish model that carries a LOF mutation both in the tsc2 and the depdc5 gene. To the best of our knowledge, this is the first time a second-hit model has been studied in zebrafish. Significantly, the DEP domain-containing protein 5 (DEPDC5) gene has an important role in the regulation of mTORC1, and the combination of a germline TSC2 and somatic DEPDC5 mutation has been described in a TSC patient with intractable epilepsy. Our depdc5−/−x tsc2−/− double mutant zebrafish line displayed greatly increased levels of mammalian target of rapamycin (mTORC1) activity, augmented seizure susceptibility, and early lethality which could be rescued by rapamycin. Histological analysis of the brain revealed ventricular dilatation in the tsc2 and double homozygotes. RNA-sequencing showed a linear relation between the number of differentially expressed genes (DEGs) and the degree of mTORC1 hyperactivity. Enrichment analysis of their transcriptomes revealed that many genes associated with neurological developmental processes were downregulated and mitochondrial genes were upregulated. In particular, the transcriptome of human SEGA lesions overlapped strongly with the double homozygous zebrafish larvae. The data highlight the clinical relevance of the depdc5−/− x tsc2−/− double mutant zebrafish larvae that showed a more severe phenotype compared to the single mutants. Finally, analysis of gene-drug interactions identified interesting pharmacological targets for SEGA, underscoring the value of our small zebrafish vertebrate model for future drug discovery efforts.
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Affiliation(s)
| | - Lise Heylen
- Laboratory for Molecular Biodiscovery, KU Leuven, Leuven, Belgium
| | | | - James D. Mills
- Department of (Neuro)Pathology Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Alessia Romagnolo
- Department of (Neuro)Pathology Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Nicole N. Van Der Wel
- Department of Medical Biology, Electron Microscopy Center Amsterdam, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Eleonora Aronica
- Department of (Neuro)Pathology Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Stichting Epilepsie Instelling Nederland (SEIN), Heemstede, Netherlands
| | - Peter A. M. de Witte
- Laboratory for Molecular Biodiscovery, KU Leuven, Leuven, Belgium
- *Correspondence: Peter A. M. de Witte,
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