Complications of Therapy for Subependymal Giant Cell Astrocytomas in Children

Surgery

• Transient hemiparesis (10–12%):  This may be related to the retraction of the medial cerebral hemisphere (7, 10).
• Permanent motor deficit (6–12.5%):  Surgery around the foramen of Monro and its adjacent anatomical structures, namely the head of the caudate nucleus, the fornix and the ependymal veins puts the internal capsule and the memory circuits at risk for transient or permanent dysfunction (7, 29).
• Hemorrhage or subdural collections (13–20%): Collapse of the hemisphere overlying the ventricle containing the tumor and trapped CSF can result in subdural blood and/or CSF. (7, 18, 26).
• Hydrocephalus (10–20%): An acute postoperative hydrocephalus, which may even be fatal, is not a rare event; it may occur in 10–20% of cases, generally secondary to infection or hemorrhage (18, 26, 29). When ventriculomegaly becomes symptomatic, steroids and/or diuretics can be used for a short-term period. When the problem persists, a ventriculoperitoneal shunt or ETV can be considered.
• Cognitive impairment: Deformation of the fornix due to the tumor and injury to the fornix during surgery may lead to postoperative cognitive impairment.
• Disconnection syndrome: Steroids and expectant treatment comprise the usual management. The syndrome resolves in 3–6 weeks without any significant residual sequelae.
• Epilepsy: Drug management should be continued for seizures. An evaluation should be done to rule out intraventricular bleeding or acute hydrocephalus (27, 30).

Chemotherapy

Rapamycin

• Common side effects manageable: The most common side effects associated with rapamycin include nausea, diarrhea, acne, dizziness, and insomnia.
• Lymphoma risk: Rapamycin can increase the risk of developing lymphoma or skin cancer. Patients should watch for unusual lumps or swollen glands
• Kidney dysfunction: People taking rapamycin also can develop kidney problems. Signs include changes in frequency of urination or color of urine, blood in the urine, or difficulty urinating.

Radiation

• Not clear: Radiation treatment is not widely used, so there is no good information on side effects or complications when it is used for SEGAs.