History of Management of Subependymal Giant Cell Astrocytomas in Children

Understanding of Disease

• 1862 – von Recklinghausen describes: TSC, also known historically as Bourneville’s disease (1880), was initially described by von Recklinghausen in 1862.
• 1880 – Bourneville describes tubers: In 1880 Désiré-Magloire Bourneville described the thickened and firm gyri or so-called cortical tubers, coining the name tuberous sclerosis. These cortical manifestations of tuberous sclerosis are still occasionally referred to as Bourneville’s disease.
• 1908 – Vogt describes triad: In 1908 Vogt reported the typical and characteristic clinical triad of the disease associating facial angiofibromatosis, epilepsy, and mental retardation (32).

Technological Development

• Less invasive approaches due to intraoperative guidance: Computer-assisted neuronavigation, intraoperative imaging with ultrasound and other modalities, and neuroendoscopy have resulted in a less invasive approach to SEGAs and an increased likelihood for complete resection of the tumor.
• Ultrasonic aspiration, improved bipolar cautery, and laser: The use of ultrasonic aspirators, Nd:YAG laser, and cutting the current on bipolar forceps have improved the control of the surgical field during tumor removal. Insulated bipolar forceps are useful for inadvertent superficial grounding and discharge of bipolar current to corticotomy walls and resection cavity.

Surgical Technique

• Tolerance of callosotomy: The interhemispheric approach first gained popularity for seizure management after Bogen and Gazzaniga demonstrated the safety of callosotomy (4). The approach provides a midline corridor and minimal tissue damage, allowing access to both the lateral and third ventricles, even when ventricles are small.
• Endoscopic management of hydrocephalus: Endoscopic fenestration of the septum pellucidum and ETV allows a minimally invasive approach for management of hydrocephalus.